Sweet syndrome in my myeloid malignancy

Sweet's syndrome is an acute febrile neutrophilic dermatosis. This condition is characterized by the sudden onset of fever and tender, erythematous, well-demarcated papules which show dense neutrophilic infiltrates on histological examination. Sweet's syndrome is often associated with hematologic disease including myeloid leukemia. Aim: Report of news cases of Sweet's syndrome. We report two cases of Sweet's syndrome occurring respectively after the use of Granulocyte-Colony Stimulating Factor [G-CSF], and the All-Trans-Retinoic-Acid [ATRA] in two females aged respectively 46 and 35 years. The outcome was favourable in the two cases

Bacterial flora and antibiotic resistance in a clinical haematology unit

Infections are among the most serious complications in neutropenic patients and are associated with an increased morbidity and mortality. Ongoing surveillance of infection in neutropenic patients is essential to detect changes in epidemiology and to guide better empirical antibiotic regimens and infection control policies. The aim of this study is to analyze the bacterial flora and the antibiotic resistance of isolates in a clinical haematology unit during three years period. From 1 January 2003 to 31 December 2005, 437 strains were isolated from different specimens. Antimicrobial susceptibility testing has been carried out by disk diffusion method as referred to the French Society of Microbiology. All susceptibility data were stored in a laboratory data base using Whonet software. Duplicate isolates defined as the same bacterial species for the same patient with the same profile of susceptibility were excluded. Gram negative bacilli [GNB] rate was 47.1% and Gram positive cocci [GPC] rate 52.9%.The most frequently identified species were coagulase negative staphylococci [CNS]: 29.3%, Escherichia coli:14%, Staphylococcus aureus: 10.7%, Klebsiella pneumoniae: 9.1% and Pseudomonas aeruginosa:7.5%. The global rate of methicillin resistant staphylococci was 27.7% for S. aureus and 61.4% for CNS, no GISA [glycopeptide intermediate S.aureus] was detected during the study period. For E. coli, the frequencies of resistance to ceftazidime, ciprofloxacin and amikacin were respectively: 45%, 26. 3% and 21.3%.Concerning K. pneumoniae, 84, 8% of strains were resistant to ceftazidime and were producing extended spectrum,-lactamase [BLSE]. The trends of resistance showed an increasing rate of K. pneumoniae BLSE: 57.1% in 2003 versus 95.5% in 2005. However; all isolates remained susceptibles to imipenem and colistin. Concerning P. aeruginosa, 50% were resistant to ceftazidime, 50% to imipenem, 51.6% to ciprofloxacin and 54.5% to amikacin. An increasing rate of imipenem resistance in P. aeruginosa was observed from 2003 to 2005[28. 6% in 2003 versus 45. 5% in 2005]. Following this study, a restriction use of ceftazidime [substituted by piperacillin-tazobatam] was instaured in the unit. A further study should be conducted to evaluate the impact of piperacillin-tazobactam as a first line treatment in neutropenic patients

[Alpha interferon in children with philadelphia chromosome-positive chronic myeloid-leukaemia]

The present work focuses on the therapeutic efficacy and the toxicity of alpha interferon in patients younger than age 18 years. 5 patients younger than 18 years were treated and followed up between 1990 and 1999 at the department of haematology [Aziza Othmana Hospital] Hydroxyurea was given as initial treatment to all patients. After a median period of 8 months. these patients received alpha interferon [5 millions units/m 2 once]. Six months after the beginning of the alpha interferon a complete hematologic response was obtained in all patients. The median overall survival was of 66 months: 3 patients are still alive [2 patients in an advanced stage and one patient in chronic phase] and 2 patients died after transformation. The most common reported side effects of alpha interferon were asthenia, weight loss, fever, myalgia, chills and headaches - these toxic manifestations were mild and were noticed in all our patients. MyeIosuppression was noted in two patients. Interferon is well tolerated in patients younger than age years 18 old, with CML.It may offer an alternative to bone marrow transplantation in children in the chronic phase of CML without histocompatible donor. The role of new agents such as STI 571 needs to be evaluated as well

[Autologous stem cell transplantation in multiple mayeloma: first experience of the "centre national de greffe de moelle osseuse" and review of therapeutic strategies]

Alkylating agents administered with prednrisone have been the standard therapy for myeloma over the last three decades. Intensive treatment with autologous hematopoietic support has become the treatment of choice for multiple myeloma patients up to 60 years of age. From march 1999 to January 2000, seven patients with multiple myeloma [stage III] with a median age of 43 years [34-56] received an outologous stem cell transplantation. The myeloablative treatment regimen consisted of high-dose melphalan. All patients had sustained engraftment. The median duration of neutropenia [<500/mm3] was 12 days [11-140] and the median duration of thrombocytopenia[<20000/mm3] was 13 days [11-110]. One patient had a complete remission, one a very good partial remission, and 5 patients had a partial remission. With a median follow- up of 8 months [2-12], all patients are alive, without relapse

[Indications and complications of central venous catheters in oncohematology: a report of 81 cases]

From February 1998 to July 1999, 81 central venous catheters were placed in 41 patients 28 years old [5 to 51 years]. We used the subclavicular anatomic way [Aubaniac] in all cases. The total duration of catheter placement was 2905 days [median of 31 days, range 1 to 165 days]. We observed 1 pneumothorax [1,2%], 3 venous thrombosis [3,7%] and 1 arterial puncture [1,2%]. Catheter-related infections were seen in 8 catheters [2,7 per 1000 catheter-days]. Candida was encountered in 4 cases [50%], Gram-positive cocci in 2 cases [25%], and Gram-negative bacilli in 2 cases [25%]. The improvment of preventive ways, diagnosis techniques [simultaneous quantitative cultures, differential positivity time], and therapeutic methods [treatment without removal of the catheter, antibiotic lock technique, catheter exchange by guidewire] should allow a better treatment of catheter-related infections