[Secondary retroperitoneal fibrosis in a 39-year-old man after rectal cancer]. / Sekundäre retroperitoneale Fibrose nach Rektumkarzinom bei einem 39-jährigen Mann.

A 39-year-old man had been treated for rectal cancer 6 years ago by lower anterior resection of the rectum and perioperative radiochemotherapy. Since then follow-up had been unremarkable but now the patient presented with unspecific lower abdominal pain. The cause of the pain was identified as paraneoplastic retroperitoneal fibrosis secondary to metachronous pulmonary metastases of the rectal cancer.

[Severe anemia and chronic alcohol abuse lacking signs of gastrointestinal bleeding in a 40-year-old]. / Ausgeprägte Anämie bei chronischem Alkoholabusus ohne gastrointestinale Blutungsstigmata bei einem 40-Jährigen.

We report about a 40 year old patient presenting a severe anemia caused by a folate deficiency combined with chronic alcohol abuse and probable liver cirrhosis. Besides pathophysiology and etiology of folate deficiency the correlation of malnutrition and liver cirrhosis (in particular caused by alcohol abuse) is discussed. As a conclusion for clinical practice the necessity of an extensive investigation for causes of an existing anemia, even in cases, which very much seem to be caused by an acute bleeding event, shall be demonstrated. Furthermore this report shows the importance of a consistent nutrition counseling of patients with liver cirrhosis.

Arsenic-induced toxicity: effect on protein composition in sciatic nerve.

Exposure to arsenic compounds may lead to skin and lung cancer and various disorders such as vascular disease and peripheral neuropathy in humans. Peripheral arsenic neurotoxicity has been demonstrated clinically and in electrophysiological studies. Patients intoxicated with arsenic show neurological symptoms in their feet and hands. These patients show significantly lower nerve conduction velocities (NCVs) in their peripheral nerves in comparison with controls. The mechanism of arsenic peripheral nervous system (PNS) toxicity, however, has never been described before. This is the first study to investigate the toxicity of arsenic on the PNS. Male Wistar rats were exposed to arsenite given as a single dose i.v. After sacrifice, sciatic nerves were excised and the protein composition was analysed. Protein analysis of sciatic nerves showed disappearance of neurofilament and fibroblast proteins in rats treated with arsenite doses of 15 and 20 mg/kg in comparison with the control groups. Some fibroblast protein bands had disappeared in the 20-mg/kg dose group. The analysed neurofilament-M and -L proteins decreased dose dependency over time. arsenic affects the composition of proteins in the rat sciatic nerve, especially the neurofilaments. The reduction of signals in Western blot analysis reveals changes in cytoskeletal composition, which may well lead to neurotoxic effects in vivo.

Cloning of two candidate tumor suppressor genes within a 10 kb region on chromosome 13q14, frequently deleted in chronic lymphocytic leukemia.

Previous studies have indicated the presence of a putative tumor suppressor gene on chromosome 13q14, commonly deleted in patients with B-cell chronic lymphocytic leukemia (B-CLL). We have previously defined a minimally deleted region of 130 kb centromeric to the marker D13S272, and constructed a PAC and cosmid contig encompassing this area. In the present study we have made a detailed restriction and transcriptional map of the region of interest. Using these tools we have screened a panel of 206 primary CLL clones and three cell lines. In five CLL cases we found limited deletions defining the region of interest to an area of no more than 10 kb. Two adjacent genes, termed Leu1 and Leu2 (leukemia-associated gene 1 and 2), were mapped to the minimally deleted region, with several patients showing deletion borders within these genes. The Leu1 and Leu2 genes show little homology to previously published genes at the nucleotide and expected translated amino acid sequence level. Mutational analysis of the Leu1 and 2 genes in 170 CLL samples revealed no small intragenic mutations or point mutations. However, in all cases of 13q14 loss examined, the first exon of both genes, which are only 300 bp apart, were deleted. We conclude that the Leu1 and Leu2 genes are strong candidates as tumor suppressor gene(s) involved in B-CLL leukemogenesis.

[Immune-mediated hemolytic anemia under oxaliplatin]. / Autoimmunhämolytische Anämie unter Oxaliplatin.

The induction of autoimmune hemolysis is a rare side effect of oxaliplatin. A 68-year-old patient was referred to our hospital because of progedient jaundice and exertional dyspnea. One day before she had received the 5th consecutive week of treatment of the 8th cycle of a chemotherapy according to FUFOX protocol with oxaliplatin and 5-fluorouracil because of metastasized adenocarcinoma of the sigma. Laboratory values revealed hemolytic anemia associated with thrombocytopenia and neutropenia. In the further clinical course a rapid decline of the hemoglobin (hb) level could be observed associated with a significant increase of hemolysis parameters. A direct Coombs test was positive consistent with oxaliplatin-mediated autoimmune anemia (AIHA) and a pulse therapy with steroids was started accompanied by transfusions resulting in a normalization of red blood cell and white blood cell counts. Chemotherapy was switched to an oxaliplatin-free regimen because of progressive tumor disease and induction of immune pancytopenia. Oxaliplatin-induced AIHA requires an immediate diagnosis since reexposition results in a more severe hemolysis. The direct Coomb's test represents the essential hallmark of the diagnosis.

A comparison between Frank and SVEC III lead systems in normal subjects.

The Frank and the SVEC III lead systems were used to record the vectorcardiograms (VCGs) of 10 normal subjects. The VCGs obtained using the two leads were compared. The QRS and the T magnitudes of the Frank lead were 25-30% and 13%, respectively, larger than those of the SVEC III. The maximum QRS vectors of the Frank lead were less inferiorly and less posteriorly oriented. Maximal T vectors of the Frank lead were less inferiorly and less anteriorly oriented. When the VCGs of 318 adult male Minnesotans (Minnesota group) recorded by the SVEC III lead system were compared with the VCGs of 510 adults from Washington, D.C. (Draper group) recorded by the Frank system, the magnitudes of QRS and T of the Draper group were larger. The percent increase of voltage was comparable to that seen when the two leads were compared in the same population. There were angular differences between the Draper and the Minnesota groups which could not be explained by lead differences. The differences were attributed to the differences in populations. It was also noted that there are significant differences in the normal values published by various authors and that the normal values obtained from one population should be applied with caution to other populations.

Cervical cytomegalovirus excretion in pregnant and nonpregnant women: suppression in early gestation.

Comparison of 659 pregnant and 202 nonpregnant women with similar demographic characteristics showed overall rates of cervical cytomegalovirus excretion that were identical (9.5% vs. 9.4%) and were surprisingly high, especially since 89% of the pregnant group possessed antibody to cytomegalovirus when admitted to the study. Prevalence of cytomegalovirus among gravidas was significantly lower during the first (1.6%) than during the third (11.3%) trimester. Thus, early pregnancy appeared to exert a suppressive effect on viral excretion that waned with advancing gestation. A similar but less significant occurrence was observed in the two groups with respect to viuria. Increasing age also appeared to suppress the virologic expression of cervical and urinary tract infection, whereas multiparity seemingly produced such an effect only in the cervix. Among both cervical and urinary excreters, a few shed virus thoughout pregnancy, and others shed virus intermittently; however, viral shedding most commonly began in late gestation and frequently continued into the postpartum period. Primary infection was not documented, and antibody status remained unchanged with the advent of viral excretion in most cases. Thus, reactivation of endogenous virus seems the most likely explanation for viral shedding in our population. Similar rates of isolation of Neisseria gonorrhoeae in excreters and nonexcreters further argue against the other major possibility, venereal reinfection.

Detailed molecular delineation of 13q14.3 loss in B-cell chronic lymphocytic leukemia.

A region of chromosome 13q14.3, telomeric to the Retinoblastoma gene RB-1 is frequently deleted in patients with B-cell chronic lymphocytic leukemia (B-CLL). A cosmid and P1-derived artificial chromosome (PAC) contig spanning over 600 kb has been constructed, which encompasses this locus. The contig clones have been used to order a number of markers along the minimally deleted region and to localize a series of CpG islands corresponding to possible candidate genes. A novel polymorphic dinucleotide repeat, 6E3.2, present in one of the ordered cosmid clones has been isolated for use in deletion mapping studies of patient DNA. Leukemic samples from 229 CLL patients have been screened for loss of heterozygosity using microsatellite markers and analyzed for hemizygous and homozygous deletions by Southern blot techniques using genomic probes selected from cosmids across the region. Hemizygous deletions were found in 31% of cases with an additional 10% showing homozygous loss. The use of these probes has defined the commonly deleted area to less than 130 kb, centromeric to the locus D13S272.