[Evaluation of microscopy methods for the diagnosis of bacterial vaginosis]

The diagnosis of Bacterial Vaginosis has always been controversial. During many years, the laboratory diagnosis of this syndrome was based on the criteria of Amsel et al (1983). This includes many factors, such us aqueous vaginal discharge, positive KOH test and the presence of clue-cells in a wet mount or Gram stain. Lately, a new diagnostic method only based on laboratory findings was performed by Nugent et al (1991), which has the advantage of being more objective and rapid. It is also easy to be used in any laboratory or even in a doctor's room. In this study, we evaluated 74 Gram stained vaginal smears and compared both Amsel et al (1983) and Nugent et al (1991) methods. Bacterial Vaginosis was diagnosed in 28% by Amsel et al (1983) criteria and in 31% by the Nugent et al (1991) criteria. The latter method seems to have a higher efficacy in diagnosing Bacterial Vaginosis, although both techniques together diagnose a higher number of cases.

Modification of pleural fluid pH by local anesthesia

BACKGROUND

It is a common practice to anesthetize patients before performing a thoracentesis. We postulated that this technique may cause a clinically significant difference in the pH of the pleural fluid.

METHODS

We compared two methods of determining pleural fluid pH. Fifty patients undergoing diagnostic or therapeutic thoracentesis were enrolled. Two 4-mL aliquots of pleural fluid were anaerobically collected into blood gas syringes containing heparin, one before (group A) and the other after (group B) anesthetizing the patient with 5 mL of 2% mepivacaine. pH was then determined on both samples using an arterial blood gas machine. Agreement analysis was performed overall and in subcategories of pH used to define complicated (<7.1), borderline (7.1 to 7.3), or uncomplicated (>7.3) parapneumonic effusions. We analyzed these same data stratified by the volume of pleural fluid in relationship to the size of the hemithorax (<15% and >15%).

RESULTS

There was a statistical difference between the mean pH in both groups (group A, 7.32; group B, 7.28; p<0.0001). There was a significant correlation between the two measures (r = 0.97; p<0.0001). Using the pH subcategories, there was 45% discordance in classification for patients with parapneumonic effusions. The pH values obtained in group B wrongly predicted whether the patient required a chest tube in two of four cases (50%). In patients with effusions that occupied <15% of the affected hemithorax, there was an 80% discordance in classification for patients with parapneumonic effusions, and the pH values obtained in group B wrongly predicted whether the patient required a chest tube in two of two cases (100%).

CONCLUSIONS

Local anesthesia is typically used before thoracentesis is performed. However, in cases of suspected parapneumonic effusions that occupy <15% of the affected hemithorax, pH results may be significantly altered by use of local mepivacaine anesthesia.

[Application of modified comparative genomic hybridization in the genetic analysis of 5 lymphoid neoplasms]

To analyze the utility of performing modified comparative genomic hybridization (mCGH) as a complementary technique to conventional cytogenetic techniques in the genetic analysis of lymphoid neoplasms. Modified comparative genomic hybridization and subsequent FISH techniques were performed in 5 lymphoid neoplasms cases diagnosed in Fundación Jiménez Díaz. The latter was done in order to confirm the results obtained with mCGH. Gains of chromosomal regions not detected with conventional cytogenetic techniques were detected by mCGH. A good correlation in the results obtained between conventional cytogenetic and mCGH techniques was observed. Nevertheless, mCGH enables the detection and subsequent identification of gains of genetic sequences undetectable with cytogenetic techniques with possible diagnostic and prognostic value.

Detection of trisomy 8 using conventional cytogenetic techniques and interphase FISH analysis in 34 myeloid disorders: a comparative study

Trisomy for chromosome 8 is one of the most common chromosome abnormalities detected in myeloid disorders. However, and despite its great incidence, its biologic significance remains poorly understood. Recently, some reports have shown the existence of masked trisomy 8 in myeloid disorders. To try to detect occult trisomy 8, we performed a study in which 34 myeloid disorders with apparent normal karyotypes using conventional cytogenetic techniques were analyzed using fluorescence in situ hybridization (FISH) analysis. Masked trisomy 8 was not detected in any of the 34 cases studied. This suggests that trisomy 8 may be a rare event in myeloid disorders in which an optimal conventional cytogenetic analysis has been performed. The acquisition of trisomy 8 either in early neoplastic stages in some cases or in late neoplastic stages in others and the absence of masked trisomy 8 suggest that this chromosome alteration may not be essential to the development of myeloid disorders.

[Detection of t(15;17) using cytogenetic, fluorescent in situ hybridization, and molecular techniques. Comparative study of 11 patients with acute promyelocytic leukemia]

OBJECTIVES

Analysis and comparison of the sensitivity for the detection of t(15; 17) with conventional cytogenetic (CC), Southern blotting (SB), metaphase fluorescence in situ hybridization (M-FISH), interphase fluorescence in situ hybridization (I-FISH) and polymerase chain reaction (PCR) techniques.

PATIENTS AND METHODS

11 acute promyelocytic leukaemia (APL) patients (9 M3 and 2 M3v) were studied at diagnosis and partial remission and analyzed with CC (11 cases), SB (7 cases), I-FISH (2 cases) and PCR (3 cases) techniques.

RESULTS

The percentages of detection of t(15;17) were: 90.9% (CC), 71.4% (SB), 85.7% (M-FISH) and 100% (I-FISH and PCR). Additional chromosomal abnormalities were detected in 2 cases with CC techniques.

CONCLUSIONS

1.- There is a very good correlation in the detection of t(15; 17) between the techniques analyzed. 2.- At diagnosis, partial remission and relapse, M-FISH and PCR provide a reliable diagnosis of t(15; 17). Nevertheless, it is important to perform a CC analysis because it enables the recognition of additional chromosome abnormalities with putative prognostic importance. 3.- At complete remission, I-FISH and PCR provide a rapid and safe screening of putative residual cells. 4.- The great sensibility of the techniques available for the detection of t(15; 17) translocation allows the use in each laboratory of the most appropriate techniques according to their substructure and the patients' clinical stage.

[Polycythemia vera as a multiphasic clonal panmyelopathy: diagnostic profile, chronic pathological progression and effect of therapy on the survival of 74 cases]

PURPOSE

1. To recognise the clinico-biological profile of a group of patients diagnosed of polycythaemia vera (PV) in our centre in the last 30 years. 2. To identify the evolutive patterns of haematological transformation. 3. To evaluate the effect of therapy on the survival.

PATIENTS AND METHODS

The clinical records of 74 patients (median age 62 years, male/female = 0.94, followed-up for 6-357 months, median 64 months) were reviewed. Clinico-biological data at diagnosis, therapy, complications and evolution of the haematological picture were evaluated in each case. The actuarial survival in the series was compared to that of the normal population.

RESULTS

The clinico-analytical data and diagnostic features were identical to other series reported. Mild increases of bone marrow reticulin was present in two thirds of the cases, overt myelofibrosis being found in only 10% of the patients. Abnormal karyotype was seen in 9% of the patients (11q-, -Y). Phlebotomy was the only treatment in eight cases, without increased incidence of thrombotic phenomena. The remainders received myelosuppressive therapy (32P, busulphan, pipobroman, hydroxyurea, etc.), thrombotic complications appearing in 8 cases and haemorrhagic complications in 4 others. One of these latter patients developed oesophageal carcinoma. The haematological picture evolved into toxic aplastic anaemia in 2 cases; myelofibrosis with myeloid metaplasia (MF/MM) in 8; myelodysplastic sindromes (MDS) in 5, three of them RAEB; and acute myelogenous leukaemia in 3 cases, two of them as the final stage of previous MF/MM and MDS/ RAEB. The actuarial survival was 71% at ten years and 46% at fifteen years, and the median survival as a whole was 13.5 years.

CONCLUSIONS

1: The treatment, mostly myelosuppressive, given to these patients attained a survival similar to that of the general population. 2: Of the cases with known evolution, 15.6% developed MF/MM, its incidence being higher in patients treated only with phlebotomy (37%). 3: The incidence of malignant evolution, i.e., to RAEB/AML, amongst those patients followed-up was 10.6%.

Aprotinin effects related to oxidative stress in cardiosurgery with mechanical cardiorespiratory support (CMCS)

There is evidence to support a relationship between oxidative stress and protease release in "ischemia-reperfusion damage." We have proposed that aprotinin may exert an antioxidant effect. A double blind clinical trial was performed with a control (G-1) and treated (G-2) groups, both submitted to CMCS. Blood samples were taken 5 times. Biochemical indicators were measured spectrophotometrically. Aprotinin was supplied by Bayer. Malonildialdehyde levels were greater in G-1 (7.2 +/- 3.6 nmoles/ml) than in G-2 (4 +/- 1.65) at the time of reperfusion. Phospholipase A2 exhibited a tendency of higher activity in G-1 than in G-2. Uric acid levels were higher in G-2 (431 +/- 274 mumoles/1) than in G-1 (224 +/- 188) at 5 minutes after aortic clamping, and catalase activity was greater in G-2 (294 +/- 55 KU/1) than in G-1 (118 +/- 47) at time of reperfusion. Low cardiac output was 10% in G-2 and 30% in G-1. Arrythmias appeared in 30% of G-2 and in 60% of G-1. These results suggest an antioxidant effect of aprotinin under ischemia-reperfusion conditions.

Fludarabine in resistant or relapsing B-cell chronic lymphocytic leukemia: the Spanish Group experience

Fludarabine produces high response rates in patients with B-cell chronic lymphocytic leukemia (CLL). Nevertheless, response to fludarabine of patients with previously treated CLL varies from 17% to 74% (0% to 38% CR). In 68 patients with heavily pretreated and advanced CLL, an overall response rate to fludarabine of 28% (4% CR) was observed. Response correlated with sensitivity of the disease to previous treatments (relapsing vs. refractory disease) (62% vs. 20%; p = 0.005) and, albeit not significantly, with the number of cycles of fludarabine (>3 vs. < or = 3) that patients could receive (36% vs. 15%; p = NS). Responding patients had a longer survival (median, not reached) than those not responding (median, 11 months) (p = 0.03). Severe toxicity was observed in some cases. It is concluded that fludarabine is a highly useful agent in CLL. However, in order to improve its effectiveness and decrease its toxicity, fludarabine should be given as soon as a lack of response to front-line therapy is observed and before the disease becomes completely resistant to therapy.

Follicular spicules of the nose: a peculiar cutaneous manifestation of multiple myeloma with cryoglobulinemia

We describe a patient with multiple myeloma and cryoglobulinemia who had spicules with a horny appearance in the follicular openings of the face, particularly on the nose. Histopathologic study demonstrated that these spicules consisted of eosinophilic homogeneous deposits in the intercellular spaces between keratinocytes in the upper layers of the follicular infundibulum. Direct immunofluorescence, ultrastructural, and biochemical investigations revealed that these eosinophilic deposits were cryoprecipitates composed of IgG-kappa with electrophoretic characteristics identical to those of the paraprotein present in the serum of the patient. Hence we believe that these lesions are best referred to as pseudohyperkeratotic spicules of the nose, and that they are a characteristic cutaneous manifestation of patients with multiple myeloma and cryoglobulinemia.

[Evolutive epidemiologic profile of myelodysplastic syndromes (1959-1993). Comparative study with acute myeloid leukemia and aplastic pancytopenias]

PURPOSE

To compare the maximum epidemiologic data attained from myelodysplastic syndromes (MDS) with those of two main panmyelopathies, namely acute myeloblastic leukaemia (AML) and aplastic pancytopenia (AP).

PATIENTS AND METHODS

A retrospective analysis was carried out on 21,135 patients included in the Bone Marrow Study Registry of the Jiménez Díaz Foundation along 35 years (1959-1993). The data were grouped into seven five-year periods. Of these, in the first three the study was performed on bone-marrow aspirates; after 1976 the histopathological study of bone-marrow biopsies was introduced, and since 1979 the karyotype has been regularly examined. The MDS were classified in accordance with the FAB system. With these premises borne in mind, the following aspects were considered: diagnostic interpretation of MDS along the years; diagnostic incidence of MDS, AML and AP in each of the five-year periods; relative frequency of those diagnosis with respect to the total number of cases; evolutive profile of sex and age at diagnosis; quantitative significance of secondary MDS-AL and toxic AP along the years; MDS subtypes and their epidemiologic characteristics.

RESULTS

A total of 510 MDS, 610 AML and 223 AP cases were identified. With respect to the sex of the MDS patients, some changes have been seen along the years, from an M/F ratio of 1.9 to 1.0; and the mean age at diagnosis raised from 53.3 years (with only 1.7% of the cases over 65 years of age) to 71.4 years (with 76.9% of the cases over 65 years of age), all this within the 1959-1989 period. The incidence of AML and AP has remained stable for the last 20 years; on the contrary, MDS have been increasing continuously along the 35 years of the study, which poses for a higher number of new cases in every period (from 35 to 119) and also for a higher relative frequency in the registry (from 1.37% to 4.40%) within the period 1959-1989. Valuable toxic history was progressively increasing in secondary MDS-AML and progressively decreasing in AP. With respect to the FAB subtypes of MDS, and taking into account the last of the five-year periods, the most frequently diagnosed were RA and RSA followed by RAEB, CMML and RAEB-T.

CONCLUSIONS

The increment of the incidence of MDS cases correlates significantly with the increment of the patients aged over 65 years. This incidence appears to be scarcely influenced by previous mutagenic agents (radiotherapy, chemotherapy) and might be due to a better understanding of MDS.

[Interphasic in situ fluorescent hybridization (FISH) in 4 cases of myeloid neoplasias with chromosome 7 changes]

The use of FISH as a complement to the conventional cytogenetic studies is of great help in attaining a better characterisation of the chromosome anomalies present in haematological malignancies, such as chromosome 7 monosomy. A study was carried out in three cases of acute non-lymphoblastic leukaemia and a myelodysplastic syndrome with chromosome 7 involvement, as shown by conventional cytogenetic studies. The Cocktail probe for chromosome 7 (DZ1, DZ2) was used (Oncor) in performing in situ hybridation. A monosomic cell line for chromosome 7, undetected by conventional techniques, was disclosed with this procedure in two of the cases. In the remaining two patients the monosomy of chromosome 7 was confirmed, although at percentages different from those attained with the conventional methods.

[Clonal myelodysplasia: prognostic stratification and therapeutic possibilities]

Myelodysplastic syndromes represent an entire group of clonal panmyelopathies with very distinct evolutionary pathways. Their common denominator, however, is a self-maintained functional failure of the myeloid hemopoiesis which tends to evolve into severe non-lymphoid leukemia (SNLL) in 20-30% of the cases. First, the prognostic value of each the following is reviewed: the morphological classification F.A.B., the stratification system for "Bournemouth group", the abnormal placement of immature myeloid precursors (ALIP) in bone marrow, and cytogenetic changes. Second, the therapeutic potential for each of the following is assessed: vitamin and support treatments; suprarenal steroids; conventional androgens and danazol; agents of cellular differentiation (cytosine arabinoside in low doses, retinoid acids, vitamin D3, etc.). Finally, the role of aggressive chemotherapies (in succession or unrelated to marrow transplant) in the eradication of myelodysplastic clone or post-myelodysplasia SNLL is examined.