Alteration in platelet function in patients with early breast cancer.

The aim of this study was to examine our hypothesis that platelets of patients with breast cancer were functionally altered compared to healthy controls. The results have shown that the platelets from women with early breast cancer released significantly more vascular endothelial growth factor (VEGF) when stimulated with thrombin, tissue factor, clotting, or over a period of time. Similarly, release of thrombospondin (TSP) with thrombin and tissue factor was higher, but failed to reach a significant level. Thus, the observed differences in platelet response support our hypothesis, but warrant further work to determine the reason underlying the observed difference and potential clinical relevance of our findings.

Agranulocytosis in rheumatoid arthritis associated with long-term flucloxacillin for staphylococcal osteomyelitis.

Agranulocytosis and septicaemia developing in a patient with rheumatoid arthritis after 3 years' intermittent treatment with diclofenac, cimetidine and flucloxacillin for staphylococcal osteomyelitis is described. Treatment with recombinant granulocyte-colony-stimulating factor and high-dose methylprednisolone had no effect on the neutropenia which resolved on stopping all drug therapy. Relapse of agranulocytosis followed reintroduction of flucloxacillin and cimetidine 3 months later.

Secondary polycythaemia associated with bilateral renal lymphocoeles.

A patient with a 15 year history of secondary polycythaemia due to renal erythropoietin hypersecretion is presented. Subsequent spontaneous development of bilateral renal lymphocoeles, which contained high erythropoietin levels, was shown by computerized tomography. The lymphocoeles were successfully treated by bilateral peritoneal marsupialization. No cause for the persistent polycythaemia or lymphocoeles was found at laparotomy or on renal biopsy.

Gastrointestinal tract aspergilloma: possible cause of malabsorption.

A 62 year old man with chronic lymphocytic leukaemia presented with malabsorption, the cause of which could not be found during life. Necropsy examination showed aspergillosis, limited to the stomach, where tumour-like masses were seen, the oesophagus, and lungs. This case illustrates the problems of diagnosing fungal infections in life and the importance of clinicopathological correlation at necropsy.

Incidence of autoantibodies to GPIIb/IIIa in chronic autoimmune thrombocytopenic purpura may be overestimated by the MAIPA.

Twenty-one serum samples from patients with thrombocytopenia and five from normal individuals were analysed by the MAIPA test to determine specificity of autoantibody reactivity against platelet glycoprotein IIb/IIIa using murine monoclonal antibodies. The sera were also analysed by dot blot to determine their anti-murine IgG activity. Two of the three patient samples positive in the MAIPA test were positive in the dot blot test for anti-murine IgG activity, and on repeating the MAIPA following preabsorption of the serum with mouse ascites proteins they gave negative results. Reactivity of the sample which did not correct by this procedure was shown to be due to an antiHPA1a alloantibody. The potential problem of human heterophile antibodies reacting with mouse antibodies in the MAIPA has been identified and a modification which corrects this has been demonstrated.

Premature vascular calcification in a case of POEMS syndrome.

A patient with classical POEMS syndrome associated with a myeloproliferative disorder is presented, in whom extensive arterial calcification was seen at an early age in the absence of other predisposing factors. Radiographs also demonstrated several small discrete sclerotic foci elsewhere in the skeleton and areas of new bone formation around the spine which were described in previous cases. Histological studies in this patient demonstrated an osteosclerotic solitary plasmacytoma of bone and Castleman's disease of lymph nodes, both of which have previously been causally associated with POEMS syndrome. In addition, dermal infiltration by mast cells was demonstrated.

A case of POEMS syndrome associated with essential thrombocythaemia and dermal mastocytosis.

We describe a case of POEMS syndrome presenting with the recognized features of polyneuropathy, organomegaly, endocrine abnormalities, monoclonal protein, skin changes and anasarca. The patient was found to have both a solitary sclerotic plasmacytoma of the pelvis and evidence of Castleman's disease of lymph nodes. A number of unusual and unique features are also documented. Histological examination of affected skin demonstrated changes similar to urticaria pigmentosa including local oedema and mast cell infiltration. There was marked thrombocythaemia which has been seen in only one previous case and in addition the patient developed diffuse vascular calcification in the absence of recognized aetiological factors. Radiotherapy of the pelvic lesion and chemotherapy to control the myeloproliferative disorder gave rise to significant improvement in neuropathy. Control of anasarca required steroid therapy in addition to diuretics. The significance of these observations is discussed in relation to previous reports.

Extramedullary haemopoietic tumours complicating polycythaemia vera.

A 52 year old man with newly diagnosed polycythaemia vera in proliferative phase developed widespread extramedullary haemopoiesis (EMH), and died as a result of cervical cord compression. At necropsy, microscopic areas of primitive cells characteristic of granulocytic sarcoma were found within a large tumour of EMH in the right retroperitoneal region. Ultrastructural analysis showed unusual hexagonal inclusions within the cytoplasm of these primitive cells. Clinicians should be aware of the possibility of discrete haemopoietic tumours, whether EMH or granulocytic sarcoma, in patients with polycythaemia vera as well as in other myeloproliferative disorders.

Macroglobulinaemia and intestinal lymphangiectasia: a rare association.

Two cases in which macroglobulinaemia was associated with intestinal lymphangiectasia are recorded. Immunoperoxidase stains demonstrated a high content of monoclonal IgM in the intestinal lymph. The seven previously recorded examples of this association are reviewed. It is concluded that the concurrence of these two conditions is not merely fortuitous, and that increased viscosity of the lymph consequent on its high IgM content may be important in the pathogenesis of the intestinal lymphangiectasia.

Platelet production time in surgery.

A study of platelet production time in major surgery is described. This was equated to the time taken for renewal of maximum malondialdehyde (MDA) activity in blood platelets following suppression by a single dose of aspirin (Stuart et al 1975). The method was simplified by using EDTA disodium salt as an anticoagulant instead of citrate, resuspending platelets with small bar magnets, and reducing time of incubation with thiobarbituric acid reagent from 1 h to 15 min. Results for maximum platelet renewal taken to be the time to achieve a pre-aspirin baseline level were median in surgery 6.3 (3.8-9.2) d and controls 7.0 (6.2-12.5) d. Using the modified method, average baseline malondialdehyde (MDA) levels were 6.2 +/- 1.4 nmol/10(9) platelets in surgical patients and 6.34 +/- 1.2 nmol/10(9) platelets in controls. Platelet production time determination using this method is not strictly analogous compared with survival of 51Cr-labelled platelets and it however warrants further study.

Static and dynamic imaging with indium-III labelled Bleomycin in the localization of squamous cell neoplasia.

Fifty two cases of squamous cell carcinoma were studied using indium-111 labelled Bleomycin. The overall accuracy of localization by static imaging alone was 80%. Detection of lung and gynaecological tumours was most consistent, while oesophageal tumours were the most commonly missed. Imaging within a few hours of administration of the radiopharmaceutical was found to be as effective as imaging at the recommended time of at least 24 hours. Inflammatory lesions giving false positive scans could be differentiated from tumour tissue by the technique of dynamic imaging. Maximum activity occurred in tumour tissue on average ten minutes after the peak for normal tissue. This difference was used to improve the detection of known tumours to 90%.