B-cell acute lymphoblastic leukemia (B-ALL): a report of 17 pediatric cases.

BACKGROUND AND METHODS: B-cell acute lymphoblastic leukemia (B-ALL) presents FAB L3 morphology and surface Ig, CD19, CD20, CD24. This pattern may show some morphological and immunological heterogeneity. Seventeen pediatric cases of B-ALL at onset, treated in twelve AIEOP Centers (Italian Association for Pediatric Hematology and Oncology), are presented. RESULTS AND CONCLUSIONS: Clinical and hematological features were characterized by low WBC counts at presentation, high M/F ratio, older age and association with extramedullary involvement. The overall survival curve at 78 months is 40%. All patients showed blasts positive for surface Ig (sIg), DR, CD19, and CD24. Ten/17 cases presented the classical features of B-ALL: FAB L3 morphology, sIg+ restricted to light chains, CD20+, cytoplasm mu (c mu)-, CD10-, TdT-. The remainder showed some differences in this pattern, such as non-L3 morphology (3 cases), absence of CD20 (3 cases), CD10+ (4 cases), TdT+ (3 cases), c mu+ (1 case), lack of surface light chains (1 case). This rare ALL subset seems to be characterized by a high phenotype heterogeneity, indicating various degrees of differentiation.

Granular acute lymphoblastic leukemia in children. "Aieop Cooperative Group for Cytology of Acute Leukemias".

BACKGROUND: Granular acute lymphoblastic leukemia (ALL) is a rare morphological variant of ALL, characterized by cytoplasmic azurophil granules or inclusions, positive for aspecific esterase and acid phosphatase, with heterogeneous features at the ultrastructural level. METHODS: In an attempt to determine whether the presence of granules or inclusions marks a biologically distinct variety of ALL with peculiar clinical features, a prospective morphological review was undertaken of children entering AIEOP protocols for ALL in the period from 1985 to 1989. RESULTS: Of 531 cases examined, 16 (3%) were found to have greater than 1% granular bone marrow blasts, with 7 cases (1.3%) having greater than 10%. The presence of granules or inclusions was associated with the immunophenotype of "common" ALL. There was no clear association with FAB type L1 or L2 nor with particular clinical or hematological findings at presentation. Complete remission was achieved in all cases; one patient died of infection in remission at 3 months and 2 patients relapsed after 12 and 32 months, respectively, while the others are still in remission after a minimum follow-up of 24 months. CONCLUSIONS: In conclusion, granular morphology seems to have no prognostic importance in children ALL.

[A case of rapid palatal expansion treated with a double telescopic screw appliance]. / Un caso di espansione rapida del palato trattato con apparecchiatura a doppia vite telescopica.

A case of maxillary hypoplasia with serious crowding in the upper arch, treated by the utilization of a special telescopic double screw permitting rapid expansion of the palate is described.

[A case of unilateral multiple agenesis]. / Presentazione di un caso di agenesie multiple monolaterali.

A case of monolateral multiple congenitally missing permanent teeth orthrodonticallq treated in the first Dept. of Orthodontics, Dental Hospital, Univ. of Turin is presented.

[Changes in laboratory and clinical parameters in subjects with chronic brucellosis treated with an immunomodulator: methisoprinol]. / Modificazioni di alcuni parametri di laboratorio e clinici in soggetti con brucellosi cronica trattati con un immunomodulante: il metisoprinolo.

In order to evaluate the immunomodulating activity of isoprinosine in chronic infections, 7 patients with chronic brucellosis unresponsive to antibiotic and corticosteroid therapy were treated with 4 g/die of isoprinosine in association with antibiotic therapy from 3 to 6 months. Immunoserologic and clinical evaluation were obtained at regular intervals from each patient. The treatment induced a significant increase of E rosette formation, reduction of erythrocyte sedimentation rate, associated with improvement or disappearance of clinical symptoms. These data suggest that isoprinosine may favourably influence the clinical course of chronic brucellosis, probably modifying host cell-mediated immune response.

[Radioimmunological determination of HAV and anti-HAV IgA in the feces of patients with acute type-A hepatitis]. / Dosaggio radioimmunologico dell'HAV e delle IgA anti-HAV nelle feci di pazienti con epatite acuta di tipo A.

58 fecal specimens from 14 patients (10 hepatitis A, 2 hepatitis B and 2 infectious mononucleosis) were tested for the hepatitis A virus (HAV) and IgA anti-HAV by micro-solid-phase-radioimmunoassay. Only patients with hepatitis A were positive for HAV and/or IgA anti-HAV. In the first days of the disease we found HAV in the feces of 4 patients but it was never present after the sixth day. In all hepatitis A we found IgA anti-HAV in at least one fecal specimen and the titer of the antibodies increased in most cases during the course of the disease. The duration and the peak of the IgA response in the feces were strongly similar to other enterovirus infections. Some methodologic improvement both for HAV and IgA anti-HAV detection are suggested.

Hepatitis B virus markers, alpha-fetoprotein and survival in fulminant viral hepatitis.

The serological markers of hepatitis B virus and serum alpha-fetoprotein (AFP) levels have been studied in 28 consecutive cases of fulminant hepatitis, correlating the data with survival. On admission, 20 patients were found to be positive for HBsAg and eight for anti-HBs. All anti-HBs-positive cases showed high titers of anti-HBc, and six patients were positive for specific anti-HBc-IgM. DNA polymerase activity was detected in serum of 11 HBsAg-positive (55%) and four anti-HBs-positive (50%) patients. HBeAg was detected in six (21.4%) subjects (five HBsAg-positive and one anti-HBs-positive), whereas anti-HBe was present in nine (32.1%) subjects (six HBsAg-positive and three anti-HBs-positive). AFP levels greater than 60 ng/ml were found in sera of 14 patients (50%). No significant difference was evidenced in the survival rate between HBsAg-positive and anti-HBs-positive and between HBeAg-positive and HBe Ag-negative patients. However, a statistically significant difference (P less than 0.05) in the survival rate was found in patients positive and negative for DNA polymerase activity and in those with AFP levels higher and lower than 60 ng/ml (P less than 0.005). Pathogenetic and prognostic significance of these findings are discussed.

[Surface antigen (HBsAg) and core antibody (anti-HBc) in chronic uremia during periodic hemodialysis treatment of hepatitis B patients. Correlation with viral replication markers (HBeAg and DNA polymerase activity)]. / L'antigene di superficie (HBsAg) e l'anticorpo anti-core (anti-HBc) nell'uremico cronico in trattamento emodialitico periodico portatore dell'hbv. Correlazioni con i markers di replicazione virale (HBeAg e attivita' dna polimerasica).

Sera of thirty-five hepatitis B surface antigen (HBsAg) positive hemodialysis patients and fifty-three asymptomatic HBsAg chronic carrier were studied to assess the relationship between markers of virus activity (hepatitis B e antigen and core-associated DNA polymerase activity) and titers of HBsAg and of antibody to hepatitis B core antigen (anti-HBc). All sera were tested by solid-phase radioimmunoassay methods. HBeAg was detected in 20 (51%) hemodialysis patients and in 14 (26%) asymptomatic carriers, whereas DNA P activity was present in sera of 21 (60%) and 17 (32%) respectively. The highest titers of HBsAg and anti-HBc expressed as P/N ratio between positive and negative controls, were detected in the majority of hemodialysis patients, whereas asymptomatic carriers showed low titers of these markers. These data suggest that in HBsAg positive hemodialysis patients a more active viral replication occurs and further underline the difference between these patients and other categories of HBsAg carriers in terms of infectivity.

[Serologic diagnosis of acute hepatitis A. Refinement and evaluation of 3 methods of determining specific anti-HAV IgM]. / Diagnosi sierologica dell'epatite acuta da virus a. Messa a punto e valutazione di tre metodiche per la determinazione delle igm specifiche anti-hav.

A solid phase radioimmunoassay (RIA) procedure was developed and three methods for detection of IgM specific antibody to hepatitis A virus (anti-HAV IgM) were compared: triple antibody method, 2-MercaptoEthanol (2-ME) for IgM cleavage and Staphylococcal A Protein (StAP) for IgG absorption. Specificity and sensitivity of the tests were checked for evaluating acute and convalescent sera from 40 patients with serologically (seroconversion) diagnosed hepatitis A and 64 sera from patients with various acute viral diseases or with high titre of rheumatoid factor (RF). Specimens to be assayed for anti-HAV IgM were pretreated with 2-ME or StAP and tested by RIa using 125I labelled anti-HAV IgG. Triple antibody method showed to be more sensitive than other two methods giving false positive result in only one serum containing high levels of monoclonal RF. No significant difference in sensitivity and specificity was found between 2-ME and StAP procedure, but these methods were able to detect anti-HAV IgM for only two weeks after the onset of the disease, whereas triple antibody method gave positive results for at last seven weeks.