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[Hematological and hematochemical signs in the diagnosis of chronic alcoholism in its early stages].

Lab tests designed to reveal the presence of pathological liver and haemopoietic organ alterations were run in 72 alcohol addicts. It was found that chronic alcoholism is more often accompanied by hypoazotaemia (90.28% of cases), increased globular volume (90.28%), increased IgA (85%), decreased blood transferrin (95.45%), and increase Ig A: blood transferrin ratio (90%) than by other signs. Liver biopsy and sternal puncture, together with gastroendoscopy, showed that these signs are constant and early evidence of initial anatomical and functional damage to the liver and blood production organs due to alcohol.

Alcoholism↗

[Chronic myeloid leukemia manifesting as gout. Reflections on secondary gout in Black Africa].

This report describes the case of a 63-year-old obese and alcoholic butcher who suffered two episodes of distal oligoarthritis. These episodes were attributed to gout on the basis of response to colchicine and demonstration of hyperuricemia. Given the presence of hepatomegaly, splenomegaly and hyperleukocytosis, a sternal puncture and myelogram were performed and led to diagnosis of chronic myelogenous leukemia. In addition to the classic predisposing factors for gout, sickle cell anemia could be implicated in Black Africa. Longer life expectancy for patients with sickle cell anemia could increase the incidence of gout in Black Africa.

Africa↗

[The mitotic cycle parameters of bone marrow cells after irradiation].

The study was performed of mitotic cycle stage distribution (G1/0, S, G2 + M) by means of flow cytometry in rats irradiated locally and totally and in 25 cancer patients receiving radiotherapy. Radiation effects manifested themselves in diminished percentage of cells in S-stage, in the block G2 + M reflecting the direct affection of myelokaryocytes. Logarithmic dependence of the quantity, of cells synthetizing DNA on radiation dose occurred in the animals in the range 0.5-6 Gy 24 hours after the exposure. Investigation of the patients' sternal puncture biopsies indicated that the proportion of S-stage cells and the value S/(G2 + M) are significant diagnostic markers of more than 1 Gy irradiation 24-48 h after the exposure. For establishing radiation overdosage these parameters proved much more informative than hemocytological indices (myelogram).

Animals↗

[Assessment of granulopoietic function reserve of the bone marrow by means of the Pyrecol-test in granulocytopenias, immature-cell leukoses and patients under antineoplastic agent therapy].

By injection of the irritating substance Pyrecol the granulopoietic reserve of the function of the bone marrow can be judged. In normal test persons the result is after 8 hours an increase of leucocytes to 176%, when the granulocytes increase to 216%. On the other hand the rate of increase in patients with undifferentiated cell leucosis is statistically highly significantly lower (2alpha = 0.01) with 115 or 132%, respectively. A higher ejection function of the bone marrow correlating with the clinical improvement is to be found after a successful therapy with cytostatics. By this the test informatively contributes to dosage and effectiveness of the therapy with cytostatics and to the course of the disease. In 6 patients with granulocytopenia of unclear genesis examined in the result of the Pyrecol-test 5 passager granulocytopenias with favourable clinical course unambiguously distinguished themselves from a pan-myelophthisis with exitus letalis. The test is easily to be performed and has no essential concomitant a-pearances. By the integral functional evidence it represents a rational supplementation of the locally demarcated morphological substrate of the sternal puncture or bone marrow biopsy, respectively.

Adolescent↗

Intravascular migration of fractured sternal wire presenting with hemoptysis.

We present a rare complication of median sternotomy in which a segment of fractured sternal wire punctured the heart, embolized to the right lung, and eroded into a bronchus causing massive hemoptysis. It was safely removed through a median sternotomy. Sternal wire fracture or migration is diagnosed easily on chest roentgenograms, but frequently goes unnoticed. Sternal wire failure can be managed nonoperatively; however, repair is indicated if fractured wires are displaced or potentially migratory.

Bone Wires↗

A procedure for placing pediatric femoral venous catheter tips near the right atrium.

OBJECTIVE: To find a body measurement that would serve as an index for determining the length of femoral venous catheter to be inserted to achieve a position near the right atrium. METHODS: A candidate index measurement was chosen, and radiographic measurements of routine femoral venous catheter placements were compared with the placement that may have resulted from use of the index in a group of patients. In a subsequent group, the candidate index was used to choose catheter insertion length, the accuracy of which was again evaluated from routine placement radiographs. RESULTS: The first series of radiographic measurements predicted that use of the sternal-umbilical-puncture (SUP) index would result in acceptable and accurate catheter tip placement. This was confirmed in the second group of patients in which 11 of 12 catheter tips were within 1 cm of the target position. CONCLUSIONS: The use of the SUP index ensures acceptable accuracy in estimating the required insertion length of femoral catheter when tip placement near the right atrium is the clinical goal.

Body Weights and Measures↗

Iron absorption during iron supplementation in blood donors.

The total amount of iron absorbed from a total supplementation of 2000 mg of iron was studied after a blood donation. 10 regular blood donors and 10 subjects without previous blood loss were included in the study. No subject had received any iron treatment before the investigation. Both groups were given one sustained release tablet containing 100 mg of iron as Fe SO4 once daily for 20 days. The iron in these tablets was labelled with 59Fe. The total amount of iron absorbed from the tablets was measured by a whole body counting technique. Laboratory tests including haematological data, desferrioxamine tests and sternal marrow punctures were made before and after the iron treatment. The non-donors lost a mean amount of 215 mg iron by phlebotomy and the total iron absorption from the tablets was only 94 mg (4.7%). In the regular blood donors the corresponding iron loss was 276 mg and the absorption was 280 mg (14%). The iron supplementation given in this study covered the iron losses in the regular blood donors but not in the non-donors. This iron prophylaxis will present a depletion but not a reduction of the iron stores in blood donors with high donation frequency.

Adult↗

Association of pyoderma gangrenosum and sterile osteomyelitis in a patient having myelodysplastic syndrome with der(1;7)(q10;q10).

Neutrophilic dermatoses such as Sweet's disease and pyoderma gangrenosum (PG) are occasionally associated with myelodysplastic syndrome (MDS). We present here a 67-yr-old male having PG and sterile osteomyelitis in association with underlying MDS (refractory anemia) and Crohn's disease. To establish the diagnosis of MDS, sternal bone marrow puncture was performed, which showed chromosomal abnormality containing der(1;7)(q10;q10). After the puncture, he suffered from gradually progressive skin ulceration, flare, and bone pain. Magnetic resonance imaging (MRI) of the sternum showed severe inflammation in the sternum and the overlying subcutaneous tissue. All of the cultures obtained from the wound were negative for both bacteria and fungus. Biopsy was performed from the antero-sternal skin lesion, which showed epidermal ulceration with prominent infiltration of neutrophils. He was thus diagnosed as having PG and sterile osteomyelitis, and was treated with prednisolone, which completely resolved the symptoms. We consider that the bone marrow aspiration in the present patient provoked PG and sterile osteomyelitis. As was previously reported by others, certain chromosomal abnormalities in MDS may be related with the development of neutrophilic dermatoses.

Aged↗

Thoracic surgery techniques of Serefeddin Sabuncuoğlu in the fifteenth century.

Serefeddin Sabuncuoğlu (1385 to 1470?) is known to be the author of the first surgery textbook, namely Cerrahiyyet'ül Haniyye (Imperial Surgery), written in Turkish in 1465. It is the first book to contain colored illustrations of surgical procedures, incisions, and instruments in the Turkish-Islamic medical literature. He was the first man to illustrate and mention introduction of a tube into the pharynx and upper esophagus, removal of foreign bodies in the esophagus by special instruments of his own design, and use of a silver ringlet in a man after tracheotomy. He also described and illustrated reduction of sternal fractures, thoracic puncture through the intercostal space for drainage of empyema cavities, and treatment of rib fractures that have severed the diaphragm. He was a humble, curious, and intelligent surgeon, and also a calligrapher and a miniature artist.

History, 15th Century↗

Percutaneous transhepatic measurement of the pressure gradient between the portal and hepatic veins.

BACKGROUND: Knowledge of the portal pressure may be of value in the assessment of patients with chronic liver disease but its measurement is problematic. AIMS: To evaluate the ease and safety of percutaneous transhepatic measurement of the pressure gradient between the portal and hepatic veins and to determine directly the need for an internal zero. METHODS: Sixty-one patients undergoing liver biopsy for suspected liver disease had pressures in branches of portal and hepatic veins measured using a flexible 22G (Chiba) needle. RESULTS: The procedure was successful in all patients, took less than ten minutes in most, and was associated with minimal discomfort. Post-procedure morbidity was similar to that of liver biopsy. Portal pressure using an external zero (either puncture site or sternal angle) was inaccurate compared with pressures obtained using the generally accepted gold standard internal zero, hepatic venous pressure, and led to incorrect classification of the presence or absence of portal hypertension in at least 10% of patients. Variations in hepatic venous pressure were not predictable on clinical grounds. The only histopathological feature predictive of portal hypertension was cirrhosis, 20 of 25 patients with and four of 36 patients without cirrhosis having portal hypertension. Of routine biochemical and haematological tests, only plasma albumin and platelet count jointly (and negatively) predicted hepatic venous pressure gradient on multiple regression analysis (R2 = 0.40). CONCLUSIONS: The use of an internal zero is essential for accurate measurement of portal pressure and this can be achieved safely using the percutaneous, transhepatic route in patients with well compensated liver disease.

Adolescent↗

[Gaucher's disease].

Two cases of Gaucher's disease are described. The diagnosis was based on clinical appearance, observation of the typical cells in the sternal and splenic puncture biopsies. Leucocytic beta-glucocerebrosidase activity was found inhibited in contrast to normal activity of the other lysosomal glycosidases. A female of 51 developed significant changes in the bones, progressive enlargement of the liver, chronic calculous cholecystitis 36 years after splenectomy. Current aspects of pathogenesis, clinical symptoms, diagnosis and treatment of Gaucher's disease are reviewed.

Adult↗

[Anemia in patients with chronic kidney failure undergoing systematic hemodialysis treatment].

A study of 24 patients with chronic renal failure and varying degrees of uremia and clinical symptoms was carried out in order to assess the mechanisms of anemia developing in patients on systematic hemodialysis for chronic renal failure. Blood clinical and biochemical parameters were evaluated. Sternal bone marrow puncture was performed to assess erythron status. Proliferative activity of bone marrow erythroid cells was assessed by autoradiography. Ineffective erythropoiesis was studied using MacManus' PAS test. The results of the study suggest that proliferative activity of bone-marrow erythroid cells is reduced while ineffective erythropoiesis is increased in patients with terminal chronic renal failure, treated by systematic hemodialysis, and largely explain the mechanism of anemia in these patients.

Adolescent↗

[Kala-azar originating in Ischia].

Four weeks after returning from a holiday on Ischia, a 53-year-old man fell ill with nocturnal sweating, fever, severe general malaise and hepatosplenomegaly. Sternal marrow and liver punctures revealed an infection with Leishmania donovani, i.e. Kala-Azar. Characteristic features were hyperplasia of the plasma cells in the bone marrow and liver, together with lymphoplasmocytoid cell wash-out and polyclonal IgG proteinaemia. Treatment with pentamidine (Lomidine) was unsatisfactory, while all manifestations of the disease regressed after two courses of sodium stibogluconate (Pentostam), although the hypergammaglobulinaemia and hyperproteinaemia disappeared only slowly. The plasma-cell hyperplasia in conjunction with the hypergammaglobulinaemia, which suggest multiple myeloma, is interpreted as a result of antibody formation by the chronic parasitic infection. Together with storage-cell hyperplasia it is also taken to be the cause of the peripheral leukopenia and thrombocytopenia.

Humans↗