Epidemiology and prevention of Clostridium difficile infections in a leukemia unit.

A 29-month prospective study was carried out in a leukemia unit with the aim of investigating the epidemiology of Clostridium difficile infections and limiting their spread. Systematic cultures of stools and assays for cytotoxin were performed on patient admission and at weekly intervals, yielding 1,355 cultures and assays. The study period was divided in period A, before total unit renovation, and period B, afterwards.

Alpha interferon in the treatment of symptomatic myelofibrosis with myeloid metaplasia.

2 patients with myelofibrosis and myeloid metaplasia had symptomatic splenomegaly and were treated with interferon alpha-2c (IFN alpha-2c). The splenic pain and pressure symptoms disappeared, accompanied by a decrease in the size of the spleen. However, the peripheral blood count worsened and no improvement in the bone marrow fibrosis could be observed.

Assessment of bone marrow blood flow using positron emission tomography: no relationship with bone marrow cellularity.

Bone marrow blood flow has been assessed using positron emission tomography and the 15O-labelled carbon dioxide steady-state technique. The measurements were performed at the site of the posterior iliac crest. The bone marrow blood flow was 10.

11q-chromosome is associated with abnormal iron stores in myelodysplastic syndromes.

Nine cases of myelodysplastic syndrome with a deletion of the long arm of chromosome #11 (11q-) showed ringed sideroblasts, and three of which had an acquired sideroblastic anemia according to the criteria of the FAB classification. In contrast, among four cases of myelodysplastic syndromes with translocation of extra material to the long arm of chromosome #11 (11q+), only one showed bone marrow sideroblasts. These results strongly indicate that an 11q- chromosome is a marker of iron overload in myelodysplastic syndromes.

A chromosomal profile of polycythemia vera.

One hundred four patients with a diagnosis of polycythemia vera and a variable period of follow-up had one or more cytogenetic investigations. Chromosome abnormalities were found in 13% of untreated patients, in 56% of cases treated with radioactive phosphorus (32P) or cytotoxic drugs, and in 85% of patients in which transformation of the disease had occurred. Nonrandom chromosome abnormalities found before treatment included +8, +9, 13q-, 20q-; their prognostic value is little, as they are often associated with longstanding, stable disease.

The spleen and haemolysis: evaluation of the intrasplenic transit time.

The mean intrasplenic red cell transit time (STT) and the slow mixing splenic red cell volume (SSV) have been measured in patients with hereditary spherocytosis (HS), autoimmune haemolytic anaemia (AIHA) and lymphoproliferative disease (LD). There was an inverse relationship between the mean red cell life span (MRCLS) and the STT in HS (r = -0.96, P less than 0.

Early AIDS cases originating from Zaïre and Burundi (1962-1976).

Three retrospectively diagnosed fatal AIDS cases are reported and discussed together with 4 other HIV seropositive patients, who all apparently contracted the HIV infection prior to the beginning of the present outbreak, without any other risk factor than heterosexual exposure in Central Africa. These data and simultaneous information from other sources contribute to the assumption that AIDS is an old disease in Central Africa. AIDS, having presented itself as a sporadic and ill defined entity, remained unrecognized in Central Africa until the outset of the present outbreak.

Multiple chromosomally distinct cell populations in myelodysplastic syndromes and their possible significance in the evolution of the disease.

Serial chromosome investigations performed in untreated myelodysplastic syndromes (MDS) revealed that: multiple chromosomally unrelated cell populations may emerge during the course of the disease; chromosome changes of the clonal type may disappear or become undetectable, and may or may not reappear during further evolution. The former of these phenomena was found in four cases and was consistently associated with clinical-haematological progression of the disease to a more malignant form, including acute leukaemia. The second was apparently unrelated to clinical and haematological changes in the evolution pattern.

Splenectomy in advanced chronic lymphocytic leukemia.

Forty chronic lymphocytic leukemia patients with splenomegaly were evaluated for splenectomy. Twenty were splenectomized. All but two normalized their hematocrit and all but one their platelet count.

[Intermittent dysfunction of a Björk-Shiley tricuspid prosthesis caused by thrombosis suspected through pulmonary scintigraphy].

Thrombosis of a Björk-Shiley tricuspid valve prosthesis was observed 4 years after its implantation. The resulting dysfunction was intermittent blocking the disc in the closed position leading to recurrent near-syncopal malaises probably due to a temporary fall in cardiac output and cerebral blood flow and a right to left interatrial shunt which was detected at pulmonary scintigraphy performed to exclude pulmonary embolism. The Björk-Shiley prosthesis was replaced with a Carpentier-Edwards n.

Trisomy 4 identifies a subset of acute nonlymphocytic leukemias.

We present four patients with acute nonlymphocytic leukemia, one M2 and three M4 French-American-British (FAB) types and one patient with refractory anemia with excess of blasts in transformation who at diagnosis had trisomy of chromosome 4 as the primary karyotypic anomaly. This chromosome anomaly probably defines a previously undescribed subset of acute nonlymphoid leukemias. Hematologic characteristics commonly found in these patients were dysplastic features of all bone marrow lineages, suggesting that trisomy 4-associated disorders involve the early myeloid hematopoietic stem cell.

Cytogenetic investigations in childhood chronic myelocytic leukemia.

Cytogenetic studies were performed on 25 chronic myelogenous leukemia patients aged between 6 mo and 19 yr. Of these, 14 presented with the adult form and 11 with the juvenile form of the disease. In patients with the adult type, 12 of 14 had a Ph chromosome and additional anomalies appearing during blastic transformation.

Quantitative assessment of erythropoiesis in bone marrow expansion areas using 52Fe.

Quantitative 52Fe scans were performed in 180 patients. Expansion of bone marrow was observed in 70. This bone marrow expansion was a nearly constant feature in haemolytic anaemia and in sideroblastic anaemia.

Acute nonlymphoblastic leukemia with bone marrow eosinophilia and structural anomaly of chromosome 16.

A patient with acute myelocytic leukemia in relapse presented with t(16;21) (p12;q22). Hematologic studies revealed a large number of abnormal eosinophils in the bone marrow. The complexity of chromosome #16 rearrangements associated with acute nonlymphocytic leukemia and the possible significance of chromosomes #16 and #21 in relation to the concomitant eosinophilia are briefly discussed.

Bronchoesophageal fistula caused by pulmonary aspergillosis.

A 29-year-old patient developed a bronchoesophageal fistula after expectorating a mycetoma caused by Aspergillus fumigatus. After failure of medical therapy, a retrosternal coloplasty was performed. Pulmonary aspergillosis can be the cause of a bronchoesophageal fistula.

Combined modality therapy for mediastinal Hodgkin's disease. Prognostic significance of constitutional symptoms and size of disease.

Combined modality therapy was used in an attempt to increase the complete remission rate and survival of previously untreated patients with Hodgkin's disease. MOPP (nitrogen mustard, vincristine, procabazine, prednisone) chemotherapy was followed by radiotherapy. The median duration of follow-up exceeded 5 years.