Whipple's disease: easily diagnosed, if considered.

Patients present with arthralgia, abdominal pain, diarrhoea and weight loss. The disease is commonly diagnosed by histological examination of small bowel biopsies, especially after staining with periodic acid-Schiff. Because of the rarity of the disease, its diagnosis is not often considered. Therefore the necessary investigations might be omitted. This case report might serve as a reminder for internists or gastroenterologists to consider Whipple's disease in patients with abdominal, articular or other symptoms after having excluded common differentials. We also review the current literature on Whipple's disease. Whipple's disease is an infectious disorder caused by Tropheryma whipplei.

Serious allergic reaction to administration of epirubicin.

A 47-year old woman was admitted for adjuvant treatment with chemotherapy consisting of epirubicin and cyclophosphamide. During the second course of chemotherapy an allergic reaction occurred after administration of epirubicin. Treatment with clemastine 2 mg iv caused a quick recovery and after 24 hours there was only a slight redness of the face. A discussion follows on allergic reactions to antracyclines and the literature is updated.

The red cell revisited--matters of life and death.

An erythrocyte-fractionating method combining volume and subsequent density separation is described. Iron isotope (59Fe)-validation proved this combination of methods to be complementary. By deploying HbA1c as cell age marker, obtained fractions demonstrated that circulating erythrocytes lose 20% of hemoglobin and membrane by shedding vesicles. Vesiculation from older cells proved to be facilitated by the spleen. Animal studies revealed that such vesicles are rapidly removed from the circulation by scavenger receptors on Kupffer cells with phosphatidylserine acting as the principal ligand. These studies reveal the existence of an alternative pathway of erythrocyte breakdown. This means that the premortal substrate of 20% of any erythrocyte is at our disposal. As this kind of vesiculation takes place during the entire erythrocyte lifespan, loss and sometimes reutilisation of marker substances limits the usefulness of isotope studies to the first half of the erythrocyte lifespan, thereby putting the dogmatic lifespan of 120 days into question. Furthermore, these studies add to the understanding of hemoglobin A1c (HbA1c) metabolism and the origin of the wide variation of erythrocyte parameters in peripheral blood. Removal of old erythrocytes from the circulation and from donor blood may open new ways into the treatment of both bilirubin and secondary iron overload.