Serum ferritin levels in hematologic malignant neoplasms

Data from 90 patients with a variety of hematologic malignant neoplasms were studied to determine the relation between changes in serum ferritin concentration and the clinical status of the patients. Patients with Hodgkin's disease, non-Hodgkin's lymphoma, multiple myeloma, blastic crisis of chronic myelocytic leukemia, acute myeloblastic leukemia and acute lymphoblastic leukemia were found to have significantly elevated serum ferritin levels. Further study of serum ferritin concentration in certain hematologic malignant neoplasms might provide a valuable insight into the role of serum ferritin determination in the diagnosis and follow-up of patients with malignant diseases.

Two new sickle cell syndromes: HbS, Hb Camden, and alpha-thalassemia; and HbS in combination with Hb Tacoma

Hemoglobin variants having electrophoretic mobility more rapid than that of HbA were identified in combination with sickle hemoglobin in two patients at the Cook County Hospital. Neither individual had symptomatic hematologic disease. In one patient, the rapidly migrating hemoglobin had the amino acid substitution characteristic of Hb Tacoma (beta-40 arg leads to ser), a mildly unstable variant. In the other patient, Hb Camden (beta-131 gln leads to glu) was identified, and the hematologic findings also indicated that he has alpha-thalassemia trait. In the patient with HbS-Camden--alpha-thalassemia, globin synthesis was unbalanced (alpha/beta 0.66), and HbS represented only 19.5% of the total hemoglobin. The latter finding suggests that under conditions of limited alpha-chain availability beta Camden may combine with alpha subunits at least as efficiently as does betaA. HbS represented 56% of the hemoglobin of the patient with HbS Tacoma, although the rate of synthesis of beta Tacoma by her reticulocytes was consistently greater than that of betaS. A time-course synthesis study demonstrated a progressive increase in the specific activity of beta Tacoma in relation to that of betaS, suggesting that the unstable beta-chains of Hb Tacoma underwent selective intracellular degradation. This process appears to explain the disparity between the rates of synthesis of the two beta chains and the relative representation of HbS and Hb Tacoma in the patient's erythrocytes.

Prevention of skateboard injuries

Skateboarding has become extremely popular in the United Kingdom, and it is estimated that over two million skateboards have been sold. Previous surveys have shown the dangers of the sport, fractures of the limbs being a particularly common form of injury. Consequently the provision of skateboard parks and the wearing of adequate protective clothing were considered necessary to reduce to severity of the injuries sustained. Our survey does not support this view, and suggests that fractures are more likely to occur in people with full protective clothing and skating in a park. The reasons for this are discussed. It is also suggested that expert instruction in the use of the skateboard has been neglected as a means of accident prevention.

Persistent ST segment elevation in left ventricular aneurysm before and after surgery

Post-myocardial infarction aneurysms are often accompanied by persistent ST segment elevations. To determine whether or not these ST segments regress following successful surgery for left ventricular aneurysms, serial electrocardiograms were studied in 74 patients and compared to changes of heart size and NYHA Functional Class. The mean postoperative follow-up period was 18.2 months (range 3 to 52 months). The mean precordial sigma ST elevation preoperatively was 5.27 mm. and 4.71 mm. after surgery (P less than 0.025). For the highest ST segment of an individual lead, the mean values were 1.9 mm. before surgery and 1.88 mm. postoperatively (P less than 0.1). Although clinical improvement occurred in 66 (89.2 per cent) by NYHA class and x-ray evidence of improvement was seen in 46 (62.2 per cent), a degree of ST elevation remained in all cases and was less elevated in only 19 (25.7 per cent). After surgery for left ventricular aneurysm, ST segments tend to remain elevated with little apparent relation to reduction of heart size or clinical improvement.

Fibrosarcoma of the mediastinum

Fibrosarcoma is a rare primary malignant tumor of the mediastinum. Three cases are presented with different presenting symptoms and clinical manifestations. Thoracotomy with biopsy of the mass is the only method for arriving at a definitive histologic diagnosis.

Giant trichobezoar--an unusual case

It has been known for several thousand years that concretions of animal and vegetable matter form in the stomachs and intestines of certain animals. These objects are known as bezoars. The finding of such curiosities in man is also recognised but is rare. A short history of bezoars is given and a case of a giant trichobezoar reported. The medical, surgical and psychiatric aspects are discussed.

Cyclophosphamide induced nail pigmentation

Cyclophosphamide therapy may occasionally cuase black pigmentation of the nails. We report five cases with this side effect and review the data on eleven cases in the literature. These changes start in the proximal nail beds and progress distally; on withdrawal of cyclophosphamide, clearing of the nail pigmentation proceeds in a similar fashion. The development of the nail pigmentation does not bear any relation to the primary condition for which cyclophosphamide was prescribed. The dose of the drug before the onset of pigmentation ranged from 1.2 to 12.3 g; the duration of treatment ranged from 10 days to 26 weeks. The mechanism of the nail pigmentation is unknown.

Transient pseudoleukocytosis caused by cryocrystalglobulinemia

A patient with Sjögren's syndrome and cryoglobulinemia was found to have pseudoleukocytosis when a leukocyte count was performed on an electronic particle counter. This apparent increase in the leukocyte count was found to be caused by spontaneous crystallization of the cryoglobulin. Further studies showed that this phenomenon was transient. Disappearance of the spontaneous crystal formation without a change in the level of cryoglobulin suggests the possibility of an interaction between the cryoglobulin and a plasma component. Factors affecting spontaneous crystallization of cryoglobulins and the laboratory as well as the clinical implications of pseudoleukocytosis are discussed.

Mediastinal lymphangioma

Mediastinal lymphangioma is an uncommon benign tumor accounting for 0.7 to 4.5% of all mediastinal masses. Lymphangiomas consist of dilated cystic lymph spaces lined by single layers of endothelium and do not undergo malignant change. Most mediastinal lymphangiomas are asymptomatic. There are no specific radiological findings. Surgical excision is the treatment of choice and the prognosis is excellent.

Acute renal failure after low-dose irradiation. A complication of chronic lymphocytic leukemia

A middle-aged woman received low-dose irradiation for treatment of chronic lymphocytic leukemia: 1,000 rads to the spleen in four sessions over four days and 400 rads to each abdominal quadrant in eight sessions over eight days. Three days after the last irradiation session, acute hyperuricemic renal failure developed and conservative treatment was begun, with use of hydration, forced diuresis, alkalization, and short-term peritoneal dialysis. Uric acid levels were carefully monitored. Renal function promptly returned to normal.

Microaggregate counts in frozen-preserved erythrocytes: effects of washing in three blood processors and filtration

Since microaggregates have been implicated in posttransfusion pulmonary insufficiency, their elimination has become an active concern in blood transfusion. Various types of filters, as well as frozen-preserved erythrocytes, have been used to provide blood relatively low in microaggregates. We have counted particles in frozen-stored blood before deglycerolization, after washing in each of three cell processing systems, and after filtration through a 40-micrometer filter. Washing frozen erythrocytes reduced the total particle counts by an average of 89%. Slight differences were found among the three blood processors with respect to particle removal. Passing washed blood through a 40-micrometer filter did not result in significant further reduction in particle counts. Hence, the use of such filters in a frozen-preserved blood system is not warranted.

The use of frozen, thawed erythrocytes in blood banking: a report of 28 months' experience in a large transfusion service

A program of component therapy using largely frozen erythrocytes was initiated at Cook County Hospital in July 1973. Use of the three existing washing systems for routine preparation of frozen erythrocytes has shown that there are differences in the levels of free hemoglobin, hematocrit, and residual glycerol in the washed products. Adenosine triphosphate, 2,3-diphosphoglycerate, and extracellular potassium and sodium were found to be within acceptable limits. Some expired units were cultured and were found to be positive for Staphylococcus and Corynebacterium. The source of contamination has not been determined. Frozen blood, when available, has been given to all patients, regardless of age or clinical condition. The incidence of transfusion reactions has decreased from 0.57% prior to the inception of the component therapy program to 0.11% since that time. Two cases of possible posttransfusion hepatitis occurred in patients who had received non-frozen blood, and in three patients who received non-frozen erythrocytes and/or components as well as frozen blood. Although the goal of the program was the use of frozen erythrocytes exclusively, only 64% use was achieved, as sufficient quantities of blood for freezing were not available at all times.

Head injury admissions to a teaching hospital

A prospective study of head injury admissions to a city teaching hospital over one year has shown that most were minor. Of the 918 patients, 85% were discharged within 48 hours, only 3% required definitive neurosurgical care, and the overall mortality was 2%. Most cases came to hospital after 5.00 p.m. especially at the weekend. Head injuries accounted for almost one-third of emergency admissions to male general surgical wards.

Hemophiliac with hemolytic anemia resulting from factor VIII concentrate

Bilateral herniorrhaphy was successfully performed on a group AB hemophiliac with cirrhosis of the liver. Adequate hemostasis was maintained with infusions of commercial factor VIII concentrates and fresh frozen plasma. An anti-A antibody mediated hemolytic reaction occurred in the postoperative period. Hemolysis subsided after the cessation of commercial factor VIII infusions. The risk of such hemolytic reactions could be eliminated through the use of group-specific cryoprecipitated factor VIII.

Acute myelofibrosis and acute myeloblastic leukaemia

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Cyclophosphamide therapy and interstitial pulmonary fibrosis

Intersitial pneumonia and pulmonary fibrosis developed in a 72-year-old man during therapy with cyclophosphamide, vincristine, and prednisone. After extensive investigations, including an open lung biopsy, cyclophosphamide appeared to be the cause of the pulmonary disease. Complete disappearance of tachypnea and the pulmonary infiltrates occurred after the discontinuation of cyclophosphamide and the institution of prednisone therapy. We concluded that the diffuse pulmonary disease in this patient was a result of cyclophosphamide therapy. The clinical and pathologic findings in this case and a review of the literature of cyclophosphamide pulmonary toxicity are reported.