Identification of masked polycythemia vera from patients with idiopathic marked thrombocytosis by endogenous erythroid colony assay

We used the methylcellulose-culture technique to determine the utility of the erythroid progenitor growth in vitro from nonadherent T-depleted bone marrow and peripheral blood cells in distinguishing polycythemia vera (PV) from essential thrombocythemia. Thirty patients with PV (group A) and 30 patients who presented with idiopathic marked thrombocytosis with platelet count greater than 1,000 x 10(9)/L and a normal or reduced hemoglobin (Hb) level (group B) were studied at initial presentation. Endogenous (erythropoietin-independent) erythroid colonies (EEC) were found in all patients in group A and 13 in group B. The numbers of EEC were comparable between patients in group A and the 13 patients with EEC in group B, 11 of whom with initial Hb levels ranging between 6.4 g/dL and 12.6 g/dL were found to have PV 2 to 45 months after initial evaluation. The number of EEC did not correlate with the time to the progression of polycythemia, whereas myelosuppression delayed the subsequent development of PV. Of the two patients with EEC in group B who did not develop PV, both received chemotherapy soon after presentation, which might preclude the evidence of polycythemia evolution. None of the other patients in group B who did not form EEC developed PV with a median follow-up of 24 months. This study indicates that the assessment of EEC in bone marrow or blood is helpful in early identification of PV or prediction of polycythemia evolution in patients with marked thrombocytosis in whom polycythemia has been initially masked or anemia is present.

The application of immunocytochemistry in diagnosis of meningeal carcinomatosis in a patient with unknown primary site

A 55-year-old female with meningeal signs was suspected to have carcinomatosis meningitis based on cytospin cytology study of cerebrospinal fluid (CSF) with Wright stain. There was no primary site of any malignancy which could be identified as the source of metastasis. Immunochemical staining for cytokeratin and carcinoembryonic antigen on suspicious large immature cells in the CSF gave positive results and confirmed the malignant nature of her disease. Intrathecal chemotherapy with methotrexate and whole brain irradiation then eradicated the symptoms rapidly. Immunocytochemistry was considered to be a very powerful diagnostic tool in management of this patient.

Modification of adriamycin-induced cytotoxicity by recombinant human interferon-gamma and/or verapamil in human stomach cancer cells

Recombinant human-interferon-gamma (rH-IFN-gamma) and verapamil (VRP), either alone or in combination, were evaluated in MTT assay for their modification effects on adriamycin-induced cytotoxicity against MKN-45, human stomach adenocarcinoma cells. VRP as a single agent did not inhibit the survival of MKN-45 at doses of up to 5.0 micrograms/ml. The survival of MKN-45 was inhibited by rH-IFN-gamma dose-dependently and further inhibited by the addition of VRP. However, the maximum growth inhibition of MKN-45 in any combination treatment with rH-IFN-gamma and VRP was less than 50% except in the highest concentration combinations (% survival: 47.9% at 10(4) U/ml of rH-IFN-gamma and 3.0 micrograms/ml of VRP). Adriamycin caused a concentration-dependent cytotoxicity and its cytotoxicity was significantly enhanced by the addition of rH-IFN-gamma and further enhanced by the combined use of rH-IFN-gamma and VRP. The modification effects of rH-IFN-gamma and VRP on adriamycin-induced cytotoxicity were evaluated in terms of modification index (MI), demonstrating that rH-IFN-gamma significantly increased in adriamycin-induced cytotoxicity and that the combined use of rH-IFN-gamma and VRP enhanced the adriamycin-induced cytotoxicity to a greater extent than did rH-IFN-gamma alone: MI values at 10(2) U/ml and 10(3) U/ml of rH-IFN-gamma were 1.7 and 3.1, respectively; those at 1.5 micrograms/ml and 3.0 micrograms/ml of VRP in the presence of 10(3) U/ml of rH-IFN-gamma were 4.4 and 6.0, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Mollaret's meningitis: a case report and literature review

Mollaret's meningitis is a rare syndrome with characteristic features. We present a case with interesting clinical course and cerebrospinal fluid studies. The patient was admitted to Veterans General Hospital-Taipei 6 times between May, 1984 and May, 1991 because of recurrent meningitis (Mollaret's meningitis). No causative etiology was identified although a series of investigations were performed, including studies of the blood and CSF, roentgenogram and nuclear scintinographs. To date, there has been no standard therapeutic modality for this disease. We use aspirin for his symptomatic control with satisfactory result though colchicine has been reported as being effective also.

FREQUENCY-DEPENDENT EFFECTS OF SINE-WAVE CRANIAL TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION IN HUMAN SUBJECTS

In a double-blind protocol, ninety healthy volunteer subjects received 30 minutes of constant current sine-wave cranial transcutaneous electrical nerve stimulation (TENS) of 5 Hertz (Hz), 100 Hz, or 2000 Hz frequency (current maintained below .5 mA for safety), placebo TENS, or no treatment. The five groups were compared on pre- to posttreatment changes in blood pressure, heart rate, peripheral temperature, and anxiety. Analysis showed significant reductions in systolic and diastolic blood pressure and heart rate after 100 Hz cranial TENS as compared to the other groups. No other differences achieved significance.

Diagnostic and prognostic values of in vitro culture growth patterns of marrow granulocyte-macrophage progenitors in patients with myelodysplastic syndrome

The in vitro culture growth of marrow granulocyte-macrophage progenitors (CFU-GM assay) was studied in 102 consecutive patients with newly diagnosed primary myelodysplastic syndrome (MDS) to determine its diagnostic utility and prognostic value. There were 18 patients with refractory anemia (RA), eight RA with ringed-sideroblast (RARS), 30 RA with excess of blasts (RAEB), 18 chronic myelomonocytic leukemia (CMML), and 28 RAEB in transformation (RAEB-T). Patients with MDS had a significantly lower number of GM colonies and a significantly higher cluster to colony ratio than those of normal controls and patients with cytopenias of other causes. Six in vitro growth patterns were observed; 85% of patients with MDS showed various abnormal growth patterns, and 42% of all MDS patients exhibited a leukemic growth pattern at diagnosis. None of the 40 patients with cytopenias of other causes had a leukemic type growth. A leukemic growth pattern was rarely observed in patients with RA and RARS (4%), but was common in other subgroups (57%). The distribution of various growth patterns was not statistically different among patients with RAEB, CMML, and RAEB-T. Thirty-six patients developed acute leukemia during the follow-up period. The MDS patients with leukemic type growth were at increased risk of rapid progression to acute leukemia, and they also had a shorter survival time than patients with a non-leukemic pattern. These results showed that simply scoring the number of CFU-GM is of limited value for the diagnosis and the prediction of prognosis of MDS, whereas the in vitro marrow culture growth pattern is of prognostic significance independently of the FAB classification. It is concluded that the in vitro growth pattern of marrow CFU-GM is helpful in diagnosing patients with MDS as well as in predicting their clinical outcome.

A clinical study of schizophrenic suicides. 42 cases in Taiwan

A clinical study of 25 male and 17 female schizophrenic suicides is presented. Jumping from a height was the most common method used. The 42 suicidal schizophrenics in Taiwan were compared with both 84 sex- and age-matched and 60 5-year illness course non-suicidal schizophrenic control groups. The suicidal schizophrenics were not significantly different from the non-suicidal counterparts of both control groups with regard to age, sex, ethnicity, religion, educational background, the presence of suicide cases in the family history, and the presence of insight, but were significantly different in characteristics of a history of previous suicide attempts, presence of psychotic symptoms during their final month, depression during their final month, a history of depression, a history of previous psychiatric hospitalizations, and the number of hospitalizations. We discuss the findings from this study and others in the literature in the context of the different clinical and socio-cultural backgrounds of these Taiwanese schizophrenic suicides.

Lack of correlation between frontalis electromyography and self-ratings of either frontalis tension or state anxiety

Since training in deep muscular relaxation is common to most behavioral treatments for anxiety and tension-related disorders, muscle tension measures, such as electromyography (EMG), would provide valuable information as to the efficacy of these treatments. In the past, however, the majority of clinical reports on behavioral treatments employing muscular relaxation have based results primarily on self-rated outcome measures, despite evidence in the literature of a lack of correspondence between self-ratings and physiological measures of muscle tension. An experiment was performed on 20 normal subjects comparing self-ratings of anxiety and frontalis muscle tension with frontalis EMG before and after a 15-min. relaxation period accompanied by frontalis EMG biofeedback. Analysis showed that the self-ratings of anxiety and frontalis tension correlated significantly both before and after the relaxation period. However, no correlation was observed between self-rated anxiety or frontalis tension and frontalis EMG either before or after the relaxation period. The relaxation period had no significant effect on the dependent measures. It is suggested that, if people are unable to report accurately on their somatic states, then physiological outcome measures, such as EMG, would be preferable to self-rated measures in assessments of relaxation training procedures.

Effects of cranial transcutaneous electrical nerve stimulation in normal subjects at rest and during psychological stress

Some effects of sub-threshold sine-wave transcutaneous electrical nerve stimulation (TENS), passed between earlobe electrodes at a constant alternating current (AC) frequency of 100 Hertz (Hz), were investigated in 90 normal subjects after 30 minutes of treatment, and after 3 minutes of standardized mental stress (mental arithmetic) which immediately followed the 30 minute treatment. In a double-blind protocol, five groups received 1) active TENS during treatment and active TENS during stress; 2) active TENS during treatment and placebo TENS during stress; 3) placebo TENS during treatment and placebo TENS during stress; 4) placebo TENS during treatment and active TENS during stress; and 5) no treatment during both treatment and stress. Results showed significant reductions in systolic blood pressure, pulse rate and anxiety, but not in diastolic blood pressure or peripheral vascular tension, after 30 minutes of active TENS as compared to no treatment. No placebo TENS effect was observed. No significant differences were observed between active TENS; placebo TENS and no treatment in physiological or psychological response to the stress procedure. Results are discussed in terms of the applicability of this technique to the management of stress.

General criteria for nonclassical photon statistics in multimode radiations

Using Muirhead's inequality based on the concept of majorization, general criteria for nonclassical photon statistics of arbitrary orders and involving any number of modes of radiations are derived. For the case of second-order correlations, it implies that both intramode antibunching and intermode bunching can contribute toward making multimode radiations nonclassical.

Dermatologic surgery--its scope and some practical aspects

Dermatologic surgery is of increasing interest to both dermatologists and other medical practitioners. It includes procedure like biopsy, excisional surgery, laser surgery, electrosurgery, curettage surgery, nail surgery, cryosurgery, minigrafting, sclerotherapy, collagen implant, punch grafting, Moh's micrographic surgery, dermabrasion and hair transplant. This article highlights the important aspects of the various procedures and some of the more important practical points.

Pyodermas: an analysis of 127 cases

In an analysis of 127 patients with pyodermas, 38 (30%) had primary pyodermas and 89 (70%) had secondary pyodermas. Seventy-one percent (71%) of the primary pyodermas were due to Staphylococcus aureus (S. aureus). Five (5%) of the primary pyodermas were due to multiple organisms. Among the patients with secondary pyodermas, 45% were due to S. aureus, 21% Streptococci, 9% Pseudomonas and 9% Proteus species. Forty-four percent (44%) of the secondary pyodermas were due to multiple organisms. S. aureus is highly sensitive to cephalothin, cloxacillin, erythromycin, methicillin and co-trimoxazole. Streptococci are highly sensitive to cephalothin, erythromycin, ampicillin and penicillin. The gram-negative organisms are sensitive to amikacin, gentamicin, kanamycin and co-trimoxazole. Cloxacillin, or erythromycin (for patients with penicillin allergy) is the antibiotic of choice in patients with primary pyodermas. In patients with infected eczemas, first-generation cephalosporin or cloxacillin is the preferred antibiotic. In patients with infected ulcers, a combination of cloxacillin and gentamicin or a cephalosporin effective against the causative agent is most suitable.

Evaluation of cerebrospinal fluid in asymptomatic late syphilis

A prospective study of the cerebrospinal fluid (CSF) of 49 previously untreated patients with asymptomatic late syphilis of more than two year's duration was conducted. The sera of all patients had reactive fluorescent treponemal antibody absorption (FTA-Abs) tests or Treponema pallidum haemagglutination tests (TPHA), and reactive or non-reactive Venereal Disease Research Laboratory (VDRL) tests. Five (10%) patients had abnormal CSF findings; these included elevated protein in four of 49 and pleocytosis in three of 49. Asymptomatic neurosyphilis, diagnosed on the basis of a reactive VDRL test of the CSF, was present in one (2%) of 49 patients.