Neurological manifestations in patients with malignant histiocytosis.

Of the 67 patients who were diagnosed with malignant histiocytosis at the Department of Medicine, Chulalongkorn Hospital, from January 1981 to May 1992, seven (10%) were found to have neurological manifestations. In five patients, neurologic diseases were the presenting clinical features. In the remaining two patients, the disease manifested at the time of relapse. Leptomeningeal infiltration, the most common pattern of involvement, was found in five patients. Involvement of the spinal cord was noted in three patients and cerebral parenchyma in two individuals. Two patients demonstrated peripheral neuropathy. Rapid clinical deterioration was observed in all patients after documentation of neurological diseases with a mean survival of 1.8 months. It is concluded that the frequency and pattern of neurological manifestations in patients with malignant histiocytosis are comparable to patients with non-Hodgkin's lymphoma. However, most patients with malignant histiocytosis manifested the neurological symptoms as an initial presentation while in non-Hodgkin's lymphoma, neurologic diseases usually manifest at the time of relapse or disease progression.

Malignant histiocytosis: a chronic variant.

An 18-year-old woman had unusual clinical manifestations of malignant histiocytosis (MH) including a long duration of massive splenomegaly, absence of lymphadenopathy, and a number of exacerbations characterized by sudden onset of fever. During life, a definite diagnosis could not be established. The antemortem pathology of the marrow and liver was nonspecific and non-diagnostic. The diagnosis of MH was made after postmortem examination by histologic and immunohistochemical studies. The long duration of massive splenomegaly suggests that this patient could represent a chronic form of MH.

Treatment of adult acute myelogenous leukemia: a pilot study at Chulalongkorn Hospital.

Twenty-seven patients with acute myelogenous leukemia (AML), aged 15 to 65 years, were treated with standard induction remission chemotherapy and two different strategies for postremission treatment. Seventeen patients (63%) achieved complete remission (CR). Nine patients (37%) died during marrow hypoplasia. The median survival of complete remitters allocated to the intensive postremission therapy is projected to be in excess of 24 months with 53 per cent probability of remaining in CR at two years. The median remission duration for patients who entered the nonintensive postremission therapy was 11 months. Age was the major factor significantly correlated with the outcome of treatment. It is concluded that intensive curative treatment should be indicated in AML patients who are less than 30 years.

Drug-induced agranulocytosis: experience in two university hospitals.

STUDY OBJECTIVE: to describe demographic data, offending drugs, clinical features, hematological profiles, clinical course, general outcome, factors influencing fatal result and microbiological aspects DESIGN: Retrospective descriptive analysis SETTING: Two university hospitals PATIENTS: 28 patients with 31 episodes of drug-induced agranulocytosis from Chulalongkorn Hospital (1976-1988) and 24 patients with 25 episodes from Songklanagarind Hospital (1983-1989) RESULTS: Female exceeds male by ratio of 2.1:1, age ranged 15-73 years. The common drugs were antimicrobial agents, penicillins and sulfonamides; antithyroid drugs; antituberculous drugs and non-steroidal antiinflammatory drugs (NSAIDs), unidentified in 16 per cent. About 61 per cent occurred more than 14 days after drug exposure. The key presentations revealed fever, prostration and sorethroat. Two marrow appearances were recognised: left-shifted granulopoiesis with few or no mature forms (type-I) in 66 per cent; and the other, selective reduction of granulocytic precursors (type-II). Penicillins, sulfonamides, antithyroid drugs and NSAIDs were all related to type-I. The leukocyte count, neutrophil and monocyte numbers were significantly higher in type-I, as well much more rapid recovery time (mean +/- SD, 4.4 +/- 1.5 vs 12.4 +/- 14.1 days, p = 0). The possible sites of infection were identified in 59 per cent, the major ones were oral cavity and GI tract. The organisms were isolated in 58 per cent from the primary sites and 25 per cent from hemocultures, of which Pseudomonas aeruginosa was the most common. The case fatality rate is 12.5 per cent. The dead victims had the higher age, and strongly association with type-II marrow appearance (p = 0.038).