Clinical Outcomes of Patients With Newly Diagnosed Acute Lymphoblastic Leukemia in a County Hospital System.

Background: Major advances in the treatment of acute lymphoblastic leukemia (ALL) over the past decade have resulted in 5-year overall survival (OS) rates of 80% in mature B cell ALL, 50% in precursor B cell ALL, 50% to 60% in T cell ALL, and 60% to 70% in Philadelphia chromosome-positive (Ph+) ALL, as reported in studies from large, specialized centers. However, many patients treated in the community have limited access to novel therapies and stem cell transplantation (HSCT).

Patients And Methods: The purpose of this retrospective cohort analysis was to evaluate the clinical outcomes of patients ≥ 16 years with newly diagnosed ALL treated from October 2007 to June 2019 in the Harris County Health System, Houston, TX.

Autoimmune hemolytic anemia in a patient with chronic lymphocytic leukemia.

Peripheral blood smear for patients with CLL and AIHA usually shows lymphoid cells with scant cytoplasm and small round nuclei with condensed chromatin, smudge cells and spherocytes.

Bortezomib, Ifosfamide, Carboplatin, and Etoposide in a Patient with HIV-Negative Relapsed Plasmablastic Lymphoma.

Plasmablastic lymphoma (PBL) is a rare subtype of diffuse large B cell lymphoma (DLBCL), often associated with HIV infection. We present a case of a 53-year-old HIV-negative man with untreated hepatitis C viral infection who presented with abdominal pain and lymphadenopathy. Lymph node and bone marrow biopsies were consistent with plasmablastic lymphoma.

Treatment of refractory thrombotic thrombocytopenic purpura with N-acetylcysteine: a case report.

Background: Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disease resulting in systemic microvascular thrombosis. The disease is caused by excessive platelet (PLT) adhesion to ultra-large (UL) von Willebrand factor (VWF) multimers inadequately cleaved by the processing enzyme ADAMTS-13. While many cases respond to plasma exchange performed with or without concurrent corticosteroids, treatment of the 10% to 20% of patients with refractory disease is difficult.

Howell-Jolly bodies: a brief historical review.

Understanding the process by which red cell precursors lose their nuclei developed in the late 19th and early 20th centuries led to the identification of nuclear remnants in circulating red cells in certain pathological states, particularly absence or decreased function of the spleen. William Howell, an American, and Justin Jolly, a Frenchman, were among a number of early contributors to this field. Early on, their names were applied, singly or in tandem, to these red cell inclusions, and the eponym, Howell-Jolly bodies, has stuck.

Erythrocyte membrane sulfatide plays a crucial role in the adhesion of sickle erythrocytes to endothelium.

Enhanced adhesion of sickle erythrocytes to the vascular endothelium and subendothelial matrix is fundamental to the development of vascular occlusion in sickle cell disease. Erythrocyte membrane sulfatide is implicated in the pathogenesis of vasoocclusive crises in sickle cell disease (SCD) patients. Because previous evidence linking sulfatide to cell adhesion has largely been circumstantial due to a lack of reagents that specifically target sulfatide, we used two sulfatide-specific strategies to address the role of erythrocyte membrane sulfatide in sickle cell adhesion to the vascular endothelium: a single-chain fragment variable chain (scFv) antibody against sulfatide as well as cerebroside sulfotransferase-deficient mice incapable of synthesising sulfatide.

Internal medicine clerkship characteristics associated with enhanced student examination performance.

Purpose: To determine which internal medicine (IM) clerkship characteristics are associated with better student examination performance.

Method: The authors collected data from 17 U.S.

Effects of diethylene glycol butyl ether and butoxyethoxyacetic acid on rat and human erythrocytes.

The toxicity of diethylene glycol butyl ether (DGBE), and its principal metabolite, butoxyethoxyacetic acid (BEAA), were assessed in vitro for rat and human red blood cells. Rat erythrocytes showed evidence of mild hemolysis when exposed to BEAA at concentrations of 5 or 10 mM for 4 h. BEAA treated rat red blood cells also showed evidence of sub-hemolytic damage: increased spherocytosis, a shift in distribution of cell size to larger cells, a significant increase in mean cellular volume, and a decrease in cellular deformability.

Butoxyacetic acid-induced hemolysis of rat red blood cells: effect of external osmolarity and cations.

Hemolysis is the principal toxicity of acute exposure to ethylene glycol monobutyl ether (EGBE) in rats. EGBE itself is not an active hemolytic agent, but its metabolite, butoxyacetic acid (BAA) formed as a result of dehydrogenase activity is a potent hemolysin. Here we address the role of osmolarity and cation composition of the suspending buffers in the mechanism of BAA-induced hemolysis of rat red blood cells in vitro.

Plasmablastic lymphomas and plasmablastic plasma cell myelomas have nearly identical immunophenotypic profiles.

Plasmablastic lymphoma is an aggressive neoplasm that shares many cytomorphologic and immunophenotypic features with plasmablastic plasma cell myeloma. However, plasmablastic lymphoma is listed in the World Health Organization (WHO) classification as a variant of diffuse large B-cell lymphoma. To characterize the relationship between plasmablastic lymphoma and plasmablastic plasma cell myeloma, we performed immunohistochemistry using a large panel of B-cell and plasma cell markers on nine cases of plasmablastic lymphoma and seven cases of plasmablastic plasma cell myeloma with and without HIV/AIDS.

Review of studies concerning the tumorigenicity of 2-butoxyethanol in B6C3F1 mice and its relevance for human risk assessment.

The U.S. National Toxicology Program (NTP) has completed 2-yr inhalation exposures in rats and mice with 2-butoxyethanol (BE).

Pappenheimer bodies: a brief historical review.

Pappenheimer is credited with describing the intraerythrocytic collections of iron, or siderotic granules, as they appear on Wright-stained blood smears of certain patients after splenectomy. The history of their description and elucidation of their origin and disposition shows the interaction of morphology with the increasing understanding of red cell physiology in the mid-twentieth century.

Red cell osmotic fragility studies in hemoglobin C-beta thalassemia: osmotically resistant microspherocytes.

Typically certain features of red cell morphology predict the results of osmotic fragility testing. Microspherocytes generally have increased and target cells decreased fragility. Blood smears in homozygous hemoglobin C disease show an interesting admixture of microspherocytes and target cells.

Danaparoid for heparin-induced thrombocytopenia: an analysis of treatment failures.

Background: Patients with heparin-induced thrombocytopenia (HIT) (with or without thrombosis) require alternative anticoagulation because of their extreme risk of new thromboembolic complications. The first effective agent for this purpose may be danaparoid, a less-sulfated low molecular weight heparinoid. Recently, direct thrombin inhibitors have been used.

Does being a clerkship director benefit academic career advancement: results of a national survey.

Background: Changes in academic medicine have left clerkship directors (CDs) anxious about their career pathway, because clerkship administrative efforts may detract from other activities.

Purpose: The Clerkship Directors in Internal Medicine (CDIM) asked members about benefits of being a CD or CDIM membership toward career development.

Methods: Responses were on 1-5 Likert scales with 5 (strongly agree).

HIV-related Hodgkin's disease with central nervous system involvement and association with Epstein-Barr virus.

Central nervous system (CNS) involvement is a rare occurrence in the course of human immunodeficiency virus (HIV)-related Hodgkin's disease (HD). We report the clinical course of a patient with HIV infection who developed systemic HD, mixed cellularity subtype, later complicated by leptomeningeal involvement. The patient died from his illness, and autopsy was performed.

In vitro sub-hemolytic effects of butoxyacetic acid on human and rat erythrocytes.

When 2-butoxyethanol (2-BE) is administered to rats, hemolysis occurs as the active metabolite butoxyacetic acid (BAA) is formed. Human red blood cells appear to be relatively resistant to the hemolytic effects of BAA in vitro, whereas rat red blood cells undergo changes in deformability, cell swelling, and hemolysis. In this study, exposure of human red blood cells to high concentrations of BAA resulted in loss of deformability and a small increase in mean cellular volume, but no significant hemolysis.

Sickle erythrocytes increase prostacyclin and endothelin-1 production by cultured human endothelial cells under flow conditions.

We investigated the effects of sickle erythrocytes on the production of vasotone mediators in endothelial cells (ECs) using an in vitro recirculating flow system. Sickle erythrocytes increased the EC production of two important vasoactivators, prostacyclin and endothelin-1, under venous wall shear stress conditions of 1dyncm2. The presence of interleukin-1 in the perfusion system, as a model for inflammatory cytokine effects, enhanced the overall amounts of released prostacyclin but did not affect the production of endothelin-1.

Regression of a plasmablastic lymphoma in a patient with HIV on highly active antiretroviral therapy.

We describe an HIV-infected 44-year-old man who presented 1 month after discontinuation of HAART therapy with a large mass extending from the mediastinum, enclosing the heart and extending through the diaphragm to the epigastric region. Biopsies subsequently revealed a highly aggressive non-Hodgkin's lymphoma (NHL) producing sheets of cells with an organoid distribution. The cells had abundant basophilic cytoplasm and a plasmacytic appearance.

Carboxyhemoglobin levels in patients with sickle-cell anemia: relationship to hemolytic and vasoocclusive severity.

Background: When carbon monoxide binds to hemoglobin, it increases the affinity of hemoglobin for oxygen and shifts the oxygen dissociation curve to the left. The resulting decrease in sickling tendency could have clinical benefit, and carbon monoxide has been suggested as a treatment for sickle-cell disease. Furthermore, in sickle-cell disease, as in other hemolytic diseases, endogenous carbon monoxide production is increased because of increased heme catabolism.

The responsibilities and activities of internal medicine clerkship directors.

Purpose: To characterize the responsibilities, activities, and scholarly productivity of internal medicine clerkship directors (CDs).

Methods: In 1999, internal medicine CDs from 122 U.S.

Calmodulin binding to the C-terminus of the small-conductance Ca2+-activated K+ channel hSK1 is affected by alternative splicing.

We identified three splice variants of hSK1 whose C-terminal structures are determined by the independent deletion of two contiguous nucleotide sequences. The upstream sequence extends 25 bases in length, is initiated by a donor splice site within exon 8, and terminates at the end of the exon. The downstream sequence consists of nine bases that compose exon 9.

Rat erythrocyte morphological changes after gavage dosing with 2-butoxyethanol: a comparison with the in vitro effects of butoxyacetic acid on rat and human erythrocytes.

Rats exposed to 2-butoxyethanol (2-BE) develop hemolysis preceded by red blood cell swelling and shape changes. In this study effects on red blood cell morphology of dosing rats with 2-BE by gavage were compared with the effects of incubation of rat erythrocytes in vitro with the principal metabolite of 2-BE, butoxyacetic acid (BAA). Morphology was assessed by bright-field and phase microscopy of Wright's stained blood smears and glutaraldehyde-fixed cells suspended in plasma or buffer.

Perfusion with sickle erythrocytes up-regulates ICAM-1 and VCAM-1 gene expression in cultured human endothelial cells.

Sickle cell anemia is characterized by periodic vasoocclusive crises. Increased adhesion of sickle erythrocytes to vascular endothelium is a possible contributing factor to vasoocclusion. This study determined the effect of sickle erythrocyte perfusion at a venous shear stress level (1 dyne/cm(2)) on endothelial cell (EC) monolayers.