Acute epiglottitis in adults.

We treated four adults whose upper airway was compromised due to acute epiglottitis. We also reviewed the English literature for all reports of this condition in adults (18 years and older). Among the 158 cases, the infectious etiology was identified in 29 (H. influenzae 20, Streptococcus pneumoniae six, H. parainfluenzae two, Streptococcus pyogenes one). In the remaining cases, the etiology was uncertain. Bacteremia was documented in 23/32 patients (71.9%), but extra-epiglottic infections were strikingly rare (X = six). The clinical manifestations were sore throat (100%), fever (88%), dyspnea (78%), dysphagia (76%), anterior neck cellulitis or tenderness (27%), hoarseness (21%), pharyngitis (20%) and anterior cervical lymphadenopathy (9%). Complete airway obstruction ensued in 23 out of the 119 subjects (18.3%) who had respiratory difficulty. Overall mortality rate was 17.6% but it was 6.4% among the patients who were semi-electively tracheostomized or endotracheally intubated. These findings illustrate that antibiotics therapy active against H. influenzae is required in the treatment of acute epiglottitis in adults. Additionally, airway patency should be established when inspiratory stridor appears assuring uncomplicated recovery.

Correlation of hypercupremia with other acute phase reactants in malignant lymphoma.

Levels of copper, haptoglobin, fibrinogen and Factor VIII were measured in 30 patients with non-Hodgkin's lymphoma on 90 occasions in an attempt to demonstrate a possible correlation between hypercupremia and other acute phase reactants. The four parameters were measured simultaneously in active disease and in remission. The serum copper, along with other parameters, was significantly elevated in the active disease (P less than 0.001) and there was a high correlation between the levels of serum copper, fibrinogen and haptoglobin (P less than 0.001).

Plasma fucosyltransferase as an indicator of imminent blastic crisis.

Plasma fucosyltransferase activity was evaluated as an indicator of an impending blastic transformation in 25 patients with chronic granulocytic leukemia (CGL). Fifteen age-and sex-matched controls were also studied. The level of enzyme activity was significantly higher in the plasma of patients with blastic transformation (1,630 +/- 570 units) compared with steady chronic granulocytic leukemia (509 +/- 110 units) and normal controls (354 +/- 57 units). In three patients with CGL, a rise in fucosyltransferase activity preceded any other clinical or laboratory parameter of blastic transformation by 16-20 weeks.