Two Down syndrome patients with an acquired translocation, t(8;14)(q11;q32), in early B-lineage acute lymphoblastic leukemia.

Two males with Down syndrome and acute lymphoblastic leukemia with the acquired translocation, t(8;14)(q11;q32), are described. In each case the constitutional karyotype was 47,XY,+21. The patients were, respectively, aged 3 years 11 months and 32 years, with presenting white blood counts 34 and 1.9 x 10(9)/L with blasts of FAB L1 and L2. In each case immunophenotype of the blasts was C-ALL. The child is alive and well and in first remission 6 years from diagnosis. In contrast, the adult patient died in first remission 8.5 months from diagnosis with severe pancytopenia. These are to our knowledge the second and third cases of ALL with t(8;14)(q11-12;q32) associated with a constitutional genetic disorder.

Prognostic factors in non-Hodgkin's lymphoma: the importance of symptomatic stage as an adjunct to the Kiel histopathological classification.

A prospective study of prognostic factors for patients with non-Hodgkin's lymphoma was carried out based on the Kiel histopathological classification. Other presentation features assessed for prognostic value included clinical features, haematological and biochemical findings, and immunochemical findings. The most powerful factors that emerged were the presence or absence of systemic symptoms and the histopathological grade of malignancy of the lymphoma (whether low or high grade). These 2 factors were largely independent. Clinical Stage I disease also carried a good prognosis, but beyond this, staging gave little further prognostic information. Nine of the group of 15 patients with Stage I high grade lymphoma have achieved prolonged disease-free survival after local therapy only. After allowing for histopathology and symptom assessment in patients with Stage II-IV disease, other factors, with the exception of C-reactive protein levels, were of minor importance.

Serial study of C-reactive protein during infection in leukaemia.

Serum C-reactive protein was studied serially by a 1-hour laser nephelometric assay in 25 patients with leukaemia who developed 34 episodes of infection. The serum level rose above, or by, 100mg/l in 29 of the episodes. Serial measurement of this acute-phase reactant was of value in detecting infection in the neutropenic patient and in monitoring the response to antibiotic therapy.

Plasmapheresis in hereditary angioneurotic edema and systemic lupus erythematosus.

A patient had hereditary angioneurotic edema coincident with systemic lupus erythematosus. This condition resulted in loss of hair, arthralgia, leukoplakia, collitis, and a nephrotic syndrome due to proliferative glomerulonephritis. The renal lesion was resistant to treatment with high-dose prednisolone and cyclophosphamide; however, sustained remission occurred after plasmapheresis. The patient has remained well for over two years since this procedure.

C-reactive protein for rapid diagnosis of infection in leukaemia.

C-reactive protein, measured in serum from 38 patients with leukaemia, was elevated to at least 100 mg/l at the beginning of 32 of 34 episodes of infection, and subsequently rose above 100 mg/l in all 34. Uninfected patients, whether in leukaemic remission or relapse and whether pyrexial or not, always had levels below 100 mg/l, with four exceptions out of 290 measurements. Estimation of two other acute-phase proteins, alpha 1-antitrypsin and orosomucoid, was not of additional diagnostic value. Serial measurement of C-reactive protein may be important for the early detection of infection in the leukaemic patient with neutropenia.

Neutrophil cytochemistry in bacterial infection.

A new cytochemical technique, sensitive to altered lysosomal membrane permeability of blood neutrophils, has been evaluated as a screening test for bacterial infection. This technique, for the lysosomal enzymes acid phosphatase and chloroacetate esterase, was compared with the neutrophil alkaline phosphatase and nitroblue tetrazolium tests. The mean score for each method was significantly higher in infected patients than in normal controls. There was, however, considerable overlap of individual scores between infected patients and ill, but uninfected, patients. This overlap limits the diagnostic value of existing cytochemical screening methods.

Lysosomal enzyme cytochemistry of blood neutrophils.

Patients with bacterial infection may show altered membrane permeability of the primary azurophilic lysosomes of blood neutrophils. A new enzyme cytochemical technique, sensitive to increased membrane permeability caused by contact of neutrophils with acetone, saponin, low pH, Streptolysin O, bacteria, and nylon wool, has been developed. The method is of potential value as a screening test for bacterial infection and for detecting neutrophil damage during filtration leucopheresis.

Serological diagnosis of infection of the urinary tract by yeasts.

Precipitins to mannan and cytoplasmic antigens of Candida albicans and Torulopsis glabrata were determined in 25 patients with colonization of the bladder urine by yeasts and in 25 control patients with bacteriuria. Precipitins were present in 64% of the patients with funguria and in 56% of the patients with bacteriuria. There was no correlation between the reactions obtained and the clinical significance of the yeast colonization. It is suggested that a single precipitin test is unhelpful in the assessment of the significance of urinary colonization by yeasts in hospital patients.

A comparison of the effect of frusemide and bumetanide on the diuretic response and fibrinolytic mechanism in man.

A double-blind, crossover trial has compared the diuretic response of ten normal male subjects to the oral administration of frusemide (40 mg) and bumetanide (1 mg). Both drugs gave a similar profile, with acute onset and cessation of response, and a marked peak effect. There was no significant difference between the times taken for each drug to produce its peak diuretic effect. The peak rate of diuretic response, and the total response for six hours after drug ingestion, were significantly greater after bumetanide, with respect to urinary volume and sodium excretion. The peak rate of magnesium excretion was greater after bumetanide. There was no difference between the drugs with respect to potassium, calcium or creatinine excretion or the urinary Na/K ratio. Following peak diuresis, potassium excretion did not show a linear return to its control value. At the time of peak diuresis, both drugs caused a significant reduction of euglobulin lysis time; levels of available plasmin were significantly lowered after frusemide, and levels of active plasmin were significantly raised after bumetanide. The significance of these findings in relation to the fibrinolytic mechanism is discussed. Estimations of plasma viscosity, serum total protein and magnesium concentrations showed that maximal haemoconcentration occurred several hours after diuresis.