Dismal outcome of therapy-related myeloid neoplasm associated with complex aberrant karyotypes and monosomal karyotype: a case report.

INTRODUCTION: Individuals who are exposed to cytotoxic agents are at risk of developing therapyrelated myeloid neoplasms (t-MN). Cytogenetic findings of a neoplasm play an important role in stratifying patients into different risk groups and thus predict the response to treatment and overall survival. CASE REPORT: A 59-year-old man was diagnosed with acute promyelocytic leukaemia. Following this, he underwent all-trans retinoic acid (ATRA) based chemotherapy and achieved remission. Four years later, the disease relapsed and he was given idarubicin, mitoxantrone and ATRA followed by maintenance chemotherapy (ATRA, mercaptopurine and methotrexate). He achieved a second remission for the next 11 years. During a follow-up later, his full blood picture showed leucocytosis, anaemia and leucoerythroblastic picture. Bone marrow examination showed hypercellular marrow with trilineage dysplasia, 3% blasts but no abnormal promyelocyte. Fluorescence in-situ hybridisation (FISH) study of the PML/RARA gene was negative. Karyotyping result revealed complex abnormalities and monosomal karyotype (MK). A diagnosis of therapy-related myelodysplastic syndrome/myeloproliferative neoplasm with unfavourable karyotypes and MK was made. The disease progressed rapidly and transformed into therapy-related acute myeloid leukaemia in less than four months, complicated with severe pneumonia. Despite aggressive treatment with antibiotics and chemotherapy, the patient succumbed to the illness two weeks after the diagnosis. DISCUSSION AND CONCLUSION: Diagnosis of t-MN should be suspected in patients with a history of receiving cytotoxic agents. Karyotyping analysis is crucial for risk stratification as MK in addition to complex aberrant karyotypes predicts unfavourable outcome. Further studies are required to address the optimal management for patients with t-MN.

Profunda femoris artery pseudoaneurysm presenting with triad of thigh swelling, bleeding and anaemia.

INTRODUCTION: We describe an alternative presentation of 2 cases of femur fractures with pseudoaneurysms of the profunda femoris artery. CLINICAL PICTURE: In both cases, there is a recurrent triad of: (1) thigh swelling, (2) bleeding from the fasciotomy wound, and (3) anaemia with a falling haemoglobin trend. TREATMENT: Surgical exploration is often not diagnostic or therapeutic. Angiography can accurately diagnose the presence of a pseudoaneurysm and intervention with coil embolisation is effective in arresting further bleeding. OUTCOME: Both cases show good outcome following coil embolisation. CONCLUSION: Recognition of this triad is necessary to ensure early accurate diagnosis so that proper treatment is rendered to prevent further recurrent bleeds.

Pain during in-patient rehabilitation after traumatic spinal cord injury.

In this prospective study, we surveyed the pain experience of 40 participants during the in-patient rehabilitation period following traumatic spinal cord injury (SCI). Twenty-eight patients (70% of the study population) had musculoskeletal (MS) pain or neuropathic (NP) pain. Pain responded positively to physical therapy and analgesics. A numerical pain scale decreased from a mean of 6.36+/-1.7 on admission to 3.2+/-1.94 on discharge (P<0.001). Paraplegic patients were more likely to have MS pain (P=0.001) and NP pain (P=0.046). There was no relationship between completeness of injury, or spinal surgery, and type of pain encountered. There was also no significant difference in the modified Barthel index between patients with and without pain on admission and discharge. We conclude that pain is a common experience in SCI patients and that it can be reduced significantly by the end of in-patient rehabilitation.

Rehabilitation outcome after primary subarachnoid haemorrhage.

Functional outcome of primary subarachnoid haemorrhage survivors was examined following rehabilitation in Singapore. Thirty-nine inpatients admitted over a 4-year period were studied retrospectively. There were 21 (53.8%) males and 18 (46.2%) females, mean age 50.9 (SD 12.7) years, at 37.3 days (SD 16.8) post-injury. Seven (17.9%) had dysphagia and 12 (30.8%) had dysphasia; 17 (43.6%) nondysphasics had cognitive impairment; 26 patients (66.7%) had Medical Research Council motor power under grade 4. Modified Barthel Index on Admission (MBIA) and Discharge (MBID) were 45.7 (SD 22.3) and 78.3 (SD 18.9), respectively (p = 0.001). Correlation between MBIA and MBID was statistically significant (r = 0.529, p = 0.001). Mean length of stay in rehabilitation was 42.3 days (SD 27.6). Thirty-four patients (87.2%) were discharged home. Nine out of 24 previously employed patients (37.5%) returned to gainful employment. Despite multiple deficits, the patients made significant functional improvement.

Frequency judgements: the problem of defining a perceptual event.

In four experiments the conditions under which frequency judgments reflect the relative frequency of complex perceptual events were explored. Subjects viewed a series of 4 x 4 grids each containing seven items, which were letters and numbers in one of four typefaces. Later judgments of the relative frequency with which particular letters appeared in particular typefaces were unaffected by a warning about an upcoming frequency judgment task, but were affected by both the time available for processing the stimuli and the nature of the cover task subjects engaged in while viewing the grids. Frequency judgments were poor when exposure durations were less than 2 s and when the cover task directed subjects' attention merely to the locations of the items within the grids. Frequency judgments improved when the cover task directed subjects' attention to the identity of the stimuli, especially to the conjunction of letter and typeface. The results suggest that frequency estimation of complex stimuli may be possible only for stimuli that have been processed as phenomenal objects.