Paroxysmal nocturnal hemoglobinuria: analysis of 40 cases

Forty cases of paroxysmal nocturnal hemoglobinuria (PNH) were studied from 1978 to 1988. Thirty patients were male and 10 were female. Their ages ranged from 15 to 58 years with a median of 32 years. Symptoms related to anemia (85%) and dark colored urine (45%) were the most frequent clinical manifestations. Seven patients (17.5%) had a previous history of aplastic anemia. The interval between the diagnosis of aplastic anemia and PNH ranged from 11 months to 26 years. All the patients had anemia with varying combinations of cytopenia. In 36 patients, bone marrow examinations were performed, and 32 were hypercellular, one normocellular and 3 hypocellular. Documented thrombosis was noted in 3 patients, involving the intra-abdominal, cerebral and renal veins, respectively. The patient with intra-abdominal venous thrombosis subsequently died of E. coli septicemia. The remaining two patients achieved complete recovery. All 40 patients were treated with corticosteroids and/or anabolic agents, 32 (80%) patients improved and 4 (10%) achieved normal hemoglobin levels. Our studies demonstrate that there is a male predominance in Chinese PNH patients and the incidence of thrombotic complications is much lower than that reported by Western countries.

Clinical nursing research priorities: a Delphi study

Using the delphi technique, a group of clinical nurse specialists was surveyed regarding delineation of clinical nursing research priorities. Upon completion of the four-round survey, the results suggested that the top priorities for nursing research are: (1) factors which influence longevity in clinical nursing practice, (2) patient care delivery systems as related to nurse satisfaction, and (3) indicators of quality nursing care.

Association of ankylosing spondylitis with IgA-multiple myeloma: report of a case and pathogenetic considerations

Multiple myeloma has rarely been reported in patients with ankylosing spondylitis. We observed a patient with a 20-year history of ankylosing spondylitis, who subsequently developed IgA myeloma. This association may not be simply coincidental. It has been proposed that the protracted stimulation of immunocytes by inflammatory lesions on the mucosal surfaces of the gastrointestinal, respiratory, and biliary tracts, where lymphocytes are already committed to IgA production, may be implicated in the pathogenesis of IgA myeloma in some patients. Ankylosing spondylitis is a chronic inflammatory disease, probably resulting from the interaction of a genetic predisposition involving HLA-B27 with an environmental event such as enteric bacterial infection. We propose that ankylosing spondylitis and IgA myeloma occurring concomitantly in our patient implies a possible pathogenetic relationship. In ankylosing spondylitis, persistent reticuloendothelial stimulation, due to chronic subclinical gastrointestinal infection, may lead to IgA-producing plasma cell activation and proliferation, and subsequent IgA myeloma development.

In vitro culture studies of blood and marrow cells in chronic myeloid leukemia at different phases of the disease

The in vitro culture growth of peripheral blood (PB) and bone marrow (BM) cells were studied simultaneously from 100 adult patients with chronic myeloid leukemia at different phases. Sixty-five patients were investigated at initial diagnosis, 30 patients in control phase, and 41 patients in blast phase. In untreated chronic phase, the relative concentrations of granulocyte-macrophage progenitor cells (CFU-GM) in BM were not significantly different from those of normal controls, but there was generally a marked increase in circulating CFU-GM. The 6 Ph1-negative patients did not show different growth characteristics. We were unable to correlate the CFU-GM number to any of the hematologic parameters as well as to the response to busulfan therapy. Pretreated patients with excessive cluster formation did not necessarily indicate impending blast crisis. In hematologic remission, the numbers of CFU-GM in both BM and PB were well within the ranges of normal controls. Culture results in blast phase revealed a spectrum of abnormal growth. In myeloid crisis, 14/29 BM and 12/29 PB samples showed increased colony and cluster formations which were composed predominantly of immature cells with variable degeneration. Marrow cells in lymphoid crisis produced low numbers of both colonies and clusters in 5 out of 8 patients, while blood cells from 8 out of 10 patients formed large amount of colonies of normal morphology. This study indicates that the in vitro CFU-GM assay may have diagnostic utility in differentiating lymphoid crisis from myeloid crisis.

Presence of HTLV-I proviral DNA in patients with adult T-cell leukemia/lymphoma in Taiwan

Human T-lymphotropic virus-I (HTLV-I) proviral DNA was demonstrated in the leukemic cells of two newly identified cases of adult T-cell leukemia/lymphoma (ATL) in Taiwan by the Southern blot hybridization method. Therefore, the ATL cases diagnosed clinicopathologically in Taiwan were, for the first time, documented to be definitely related to HTLV-I.

Bacillus thuringiensis and related insect pathogens

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Prognostic significance of in vitro marrow culture growth pattern in untreated acute nonlymphocytic leukemia

The growth pattern of marrow cells in agar culture was studied in 90 adult patients with acute nonlymphocytic leukemia (ANLL) at diagnosis. We classified the abnormal growth patterns into 4 groups, A: no growth, B: decreased growth, C: excessive microcluster formation and D: excessive cluster growth with more than 20 colonies. There was a good correlation between growth pattern and FAB subtype. A predominance of group A growth was observed in M1, while group B growth was found in 50% of patients with M2 and M5. No relationships between the growth patterns and other clinical parameters were detected. Sixty-six patients were evaluable for treatment outcome. The growth pattern significantly correlated with complete remission rate. The remission rates were 52, 87, 80, and 25% for patients with group A, B, C and D growth, respectively. Analyses of remission duration and survival curves showed significant differences among the different growth patterns. Patients with D growth experienced a shorter remission duration and a lower survival rate than other groups. These results indicate that the in vitro culture growth pattern in untreated ANLL is of prognostic significance in predicting the response to therapy.

A device for interstitial therapy of low pelvic tumours--the Hammersmith perineal hedgehog

The freehand production of accurate volume or multiplane implants for interstitial therapy is difficult. The size of tumour that may be treated in this fashion is therefore limited. A solution to this problem is to use a perspex template to guide the implant and maintain its configuration during treatment. We describe our experience using such a template (the Syed-Neblett template) in treating pelvic tumours. The device has been adapted for use with the iridium wire available in the UK. Two new templates have been designed which are more versatile for treating tumours in this area. Ten patients have been treated and with appropriate analgesia, antibiotic cover and nursing care the implant was well tolerated.

Puffability People: a new way to promote health

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Reduction of teenage pregnancy as a rationale for sex education: a position paper

There is little doubt that the present level of interest in initiating sex education programs in the schools stems from the effort to reduce the teenage pregnancy rate. While one can hardly challenge the respectability of the goal to reduce teenage pregnancy, the writers take the view that the focus on reducing teenage pregnancy may be counter-productive to the establishment of effective sex education programs in school for the following reasons. 1. It promotes a narrow and incorrect understanding of human sexuality and sex education. 2. It creates misunderstanding of what constitutes a comprehensive sex education program. 3. Because the focus is on the junior/senior high youngster the assumption is left that sexuality occurs only between grades six and twelve. 4. It focuses primarily on the female and provides little education for the male. 5. It implies that the majority of teenagers want sex and not babies. 6. It implies that advocating sexual restraint is moralizing (and moralizing is bad) but teaching students that they should use contraceptives to avoid pregnancy is not moralizing. 7. The contraception approach presents human sexuality as a negative behavior because it conveys the impression that sex will get you into trouble if you do not know what to do.

Far-field holography of ampule contaminants

Detection and measurement of contaminating particles in cylindrical ampules have been achieved using far-field holography. The degradation of the images caused by the cylindrical nature of the ampule was overcome by index matching and clear images of particles as small as 5 microm in diameter were obtained.