Atypical blast crisis in chronic myelogenous leukemia.
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Aged↗
Biomedical subjects
D B Okun
Publications and source records attributed to D B Okun.
Hand-mirror cell leukemia. Report of nine cases and a review of the literature.
In order to determine the significance of 40% or more leukemic cells in hand-mirror configuration in the bone marrow (hand-mirror cell leukemia), eight of 34 cases of acute lymphoblastic leukemia and one of 17 cases of acute myeloblastic leukemia were collected from a six-year period. Five of the eight patients who had acute lymphoblastic leukemia were children; the remaining patients were less than 40 years of age. Females outnumbered males two to one. Cytochemical and electron-microscopic studies were performed for three cases. The clinical presentations were similar to those of patients without the hand-mirror cell variant, except for a high incidence of central nervous system relapses (over 50% of patients) despite prophylaxis. When compared with patients with acute leukemia in equivalent age and morphologic categories, adults with the hand-mirror cell variant had a similar, but not better, prognosis, while children with the variant had a poorer prognosis. Additional studies must be performed to determine whether the hand-mirror cell variant warrants separation from other forms of acute leukemia.
Adult↗
Acute leukemia in pregnancy: transient neonatal myelosuppression after combination chemotherapy in the mother.
An 18-year-old primagravida received combination chemotherapy with vincristine, prednisone, L-asparaginase, cyclophosphamide, daunomycin, 6-mercaptopurine and central nervous system (CNS) prophylaxis with intrathecal methotrexate and whole-brain irradiation for acute lymphoblastic leukemia (ALL) beginning in the 12th week of pregnancy. Therapy resulted in sustained complete remission of the leukemia and delivery of a normally developed female infant whose immediate neonatal course was complicated by transient severe bone marrow hypoplasia. Our experience confirms the reports of others that intensive chemotherapy can be administered in the last two trimesters of pregnancy without serious teratogenic complications. However, we conclude that such therapy may cause significant myelosuppression in the newborn.
Antineoplastic Agents↗
Bone marrow granulomas in Q fever.
This report describes the case of a patient who had a fever of unknown origin and granulomatous hepatitis. Numerous granulomas were present in sections from a bone-marrow biopsy and bone-marrow clot obtained as a part of the diagnostic evaluation. Subsequent serologic studies proved the patient had Q fever. The authors re-emphasize that a distinctive form of granuloma occurs in the bone marrow with Q fever and that Q fever should always be a consideration in the differential diagnosis of bone-marrow granulomas.
Adult↗
Heroin-induced thrombocytopenia.
Six cases of acute thrombocytopenic purpura occurred secondary to heroin abuse. Five of the six affected patients were seen over a six-month period between November 1977 and March 1978, and the last patient was seen in November 1978. The clinical manifestations were characteristic of drug-induced immune thrombocytopenia. We suspect this syndrome is related to a new adulterant added to local street heroin.
Acute Disease↗
Profound leukemoid reaction in cytomegalovirus mononucleosis.
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Adult↗
Leukocyte alkaline phosphatase.
In summary, LAP is an intriguing enzyme and its control is related to pituitary-adrenal function. A review of the changes in LAP activity which occur in some physiological conditions and in disease states has been presented. The function of LAP, however, is unknown. Table I summarizes those conditions in which the LAP is consistently altered enough so to help in the diagnosis of the disorder. Of prime importance is the differentiation of CML from a leukemoid reaction or agnogenic myeloid metaplasia with a leukocytosis. However, in no instance is the LAP value alone diagnostic of any disease. It remains a laboratory test to be utilized in conjunction with all other available clinical data.
Alkaline Phosphatase↗