[Hematologic neoplasms and pregnancy]. / Neoplasias hematológicas y embarazo.

Hematologic neoplasms diagnosed during pregnancy, present significant difficulties in patient management. Besides the strictly medical facts, moral, ethical and religious issues should be strongly considered. For the optimal management of individual situations an integrated multidisciplinary approach is mandatory. Hodgkin's disease, acute leukemias, non Hodgkin's lymphoma and less frequently chronic myelogenous leukemia have been reported in pregnant women. Curative treatment for most of these diseases include intensive chemotherapy regimens. Potential damage to the fetus is a major concern, due to the teratogenic effects of antimetabolites, alkylating agents and radiation therapy. Effect of pregnancy in each of these neoplasms is discussed. Although some rules of management exist, dangerous generalizations should be avoided. Particular obstetric considerations such as timing of delivery, and therapeutic abortion should be carried out on an individual basis. The emotional impact of the situation must not be underestimated.

[Bone marrow granulomas]. / Granulomas en medula ósea.

PURPOSE: To evaluate bone marrow granulomatous lesions in order to establish their etiology. MATERIAL AND METHODS: 2,250 bone marrow biopsies were studied during the period of March 1983-March 1991. Granulomas and/or granulomatous lesions were found in 24 of them (1.06%). A correlation between histological characteristics, special stains: PAS, Ziehl Neelsen and Grocott and cultures were done. Immunohistochemistry was done to evaluate B or T cell-lineage in 4 patients. RESULTS: The 24 patients were biopsied because of the clinical diagnosis of haematological and non-haematological neoplasias, infections, AIDS, sarcoidosis and fever of unknown origin. Bone marrow cellularity ranged from 20% to 75% (M: 49.8%). Myeloid cells were increased in 54% of the cases. The number of granulomas ranged from 1 to 19 (M: 3.9). The epithelioid cells were the predominant component in 66% of the cases. Of the 7 patients with non-Hodgkin's lymphoma, 4 had lymphomatous involvement with granulomatous pattern. These cases showed predominance of lymphoid cells and vessels in addition to epithelioid cells. CONCLUSION: We consider that in order to establish a relationship between infection and granuloma, the identification of a microorganism through a culture is a more reliable test. We couldn't find any morphological characteristic which allowed an etiologic diagnosis of bone marrow granulomas. In case of lesions with a great lymphocytic and vascular proliferation plus the presence of epithelioid cells and fibrosis, NHL with bone marrow involvement with a granulomatous pattern should be strongly considered.

Consumption coagulopathy in acute renal failure induced by hypolipotropic diets.

Weanling male rats fed on a hypolipotropic diet develop acute renal failure whose morphological features vary from focal tubular necrosis to cortical necrosis. We have sequentially studied the hemostatic mechanism in correlation with the morphology of various tissues, mainly renal and hepatic, in choline-deficient rats as well as in three control groups. No important changes were observed in the hemostatic mechanisms before the development of tubular necrosis. Along with tubular necrosis a consumption coagulopathy was found, evidenced mainly by a decrease in the activity of factors V and VIII as well as a prolongation in PTTK and Quick's time and a decrease in platelets. Fibrin degradation products were found in serum and urine and soluble fibrin monomer complexes in the former. Following tubular necrosis thrombi were found in the renal microvasculature. It is possible to speculate that the tubular necrosis induced by choline deficiency could produce an activation of the coagulation system which in turn would lead to thrombosis of the renal microcirculation and cortical necrosis.