Transient recurrence of chemotherapy-induced peripheral neuropathy in the immediate postoperative period following gynaecological surgery under general anaesthesia.

Peripheral neuropathy is a well-described side effect of certain chemotherapeutic agents, including taxanes, and often improves in the weeks following treatment. The recurrence of motor and sensory neuropathies after anaesthesia has not yet been described to our knowledge. We present a case of transient recurrence of chemotherapy-induced peripheral neuropathy following general anaesthesia. Although an exact mechanism has not yet been described and is likely multifactorial in nature, anaesthetists should be prepared to address this phenomenon in the growing population of patients on chemotherapeutic agents.

Type IV Ehlers-Danlos syndrome with aspirin sensitivity. A family study.

The purpose of this study was to investigate a family with type IV Ehlers-Danlos syndrome (EDS-IV) and platelet sensitivity to aspirin, an association that, to our knowledge, has not been reported previously. Type IV Ehlers-Danlos syndrome is a rare disorder of type III collagen metabolism characterized by bruising easily and death at an early age from exsanguination by rupture of a major viscus or artery. Previous studies have suggested an association between various types of Ehlers-Danlos syndrome and abnormal platelet function. In this family, EDS-IV is inherited in an autosomal dominant pattern. The transmission of the platelet functional disorder from the proband to only one of two children affected with EDS-IV in this family suggests that there is a genetic component to this condition that is independent of EDS-IV.

Copper deficiency and sideroblastic anemia associated with zinc ingestion.

Anemia and neutropenia developed in a man who took pharmacologic doses of supplemental zinc. Laboratory investigation showed high zinc level, hypocupremia, low ceruloplasmin level, and ringed sideroblasts. All resolved after withdrawal of zinc. Self-administered zinc appears to have caused severe copper deficiency, with secondary anemia and neutropenia. Physicians should be aware of this deleterious and completely reversible effect of megadose mineral therapy. Zinc ingestion or exposure should be considered in the differential diagnosis of unexplained anemia, leukopenia, or sideroblastic anemia.

Factor VIII antibody in a patient with mild haemophilia.

We present the rare occurrence of an inhibitor of factor VIII procoagulant arising in a patient with mild haemophilia A and rheumatoid arthritis. The inhibitor was transient and behaved like a low titre, type II factor VIII procoagulant inhibitor similar to previously reported cases (Biggs et al, 1972b). In vitro studies confirmed the type II-like interaction of this inhibitor with the factor VIII procoagulant molecule. Factor VIII procoagulant antigen level was equal to the factor VIII procoagulant activity, which excluded dysproteinaemia as the cause. This patient's HLA type has no known association with abnormal immune responsiveness or autoimmune disease, and his clinical course as well as in vitro studies were similar to the eight previously reported cases of factor VIII procoagulant inhibitors arising in mild haemophilia A.

Hemorrhagic diathesis in multiple myeloma.

Hemorrhage occurs during the clinical course in 15% of patients with multiple myeloma. We recently treated a patient with myeloma who had postoperative bleeding and hematuria despite normal coagulation parameters and platelet count. Platelet function studies revealed markedly abnormal aggregation to all stimulants. Plasma exchange successfully reversed in vitro and in vivo bleeding abnormalities.

Pure RBC aplasia and myasthenia gravis. Coexistence of two diseases associated with thymoma.

Pure RBC aplasia (PRCA) and myasthenia gravis (MG) are occasionally associated with thymoma, although the occurrence of all three in a single patient is rare. We describe a patient in whom PRCA and MG occurred in conjunction with the presence of serum autoantibodies, evidence for a serum inhibitor of erythropoiesis, and elevation of circulating thymosin alpha 1. Although a thymoma could not be detected before death, postmortem examination of the mediastinum found scattered cells within a nodule, suggestive of a lymphoepithelial thymic neoplasm.

Immunoblastic lymphadenopathy: failure of, rather than lack of immunoregulation.

The lymphoid proliferation characteristic of immunoblastic lymphadenopathy is polyclonal and of B cell lineage. This proliferation of B cells could result from an inherent B cell defect, prolonged and pronounced antigenic stimulation, or inadequate immunoregulation. We recently evaluated a patient with this disorder and found excessive T cell mediated in vitro suppression of both the autologous and allogeneic blastogenic response to mitogen. This enhanced in vitro suppression suggests that the clinically observed lymphoid proliferation in this patient occurred because of autonomous or excessively stimulated B cells and not because of a lack of functional suppressor cells.