Warfarin-induced skin necrosis.

Skin necrosis is a rare but serious side-effect of treatment with warfarin. At particular risk are those with various thrombophilic abnormalities, especially when warfarinization is undertaken rapidly with large loading doses of warfarin. With the increasing number of patients anticoagulated as out-patients for thromboprophylaxis, we are concerned that the incidence of skin necrosis may increase. If skin necrosis does occur, prompt remedial action may be of benefit in preventing permanent tissue damage.

CHOP-based chemotherapy is as effective as alternating PEEC/CHOP chemotherapy in a randomised trial in high-grade non-Hodgkin's lymphoma. Scotland and Newcastle Lymphoma Group.

The aim of this study was to test whether survival for patients with high-grade non-Hodgkin's lymphoma (NHL) can be improved with a non-cross-resistant regimen as compared to a CHOP-based regimen. This is a multicentre study comprising 325 adult patients, median age 58 years, with high-grade non-Hodgkin's lymphoma: patients of any age and performance status were eligible provided they were able to receive the drugs in the regimens. Patients were randomised to either B-CHOP-M (bleomycin, cyclophosphamide, doxorubicin, vincristine, prednisolone and methotrexate) or PEEC-M (methylprednisolone, vindesine, etoposide, chlorambucil and methotrexate) alternating with B-CHOP-M. At a median follow-up of 9 years, there was no significant difference in overall survival or disease-free survival between the two arms. Toxicities for the two regimens were equivalent. This study confirms that for relatively unselected patients with high-grade non-Hodgkin's lymphoma, an alternating multidrug regimen does not improve upon the results obtained with B-CHOP-M.

Treatment of sulphasalazine-induced agranulocytosis with granulocyte macrophage-colony stimulating factor.

Sulphasalazine-induced agranulocytosis is a rare but potentially life threatening complication. A variable mortality rate has been reported, from 6% to 20%, and is related to the duration of neutropenia. Previous case reports have shown that the use of granulocyte macrophage-colony stimulating factor (GM-CSF) in treating drug-induced agranulocytosis may shorten the period of neutropenia and hence lead to improved survival. It may also be a less costly treatment option that supportive care alone due to reduction of hospital stay as a consequence of a shortened duration of neutropenia. We report a case in which sulphasalazine had been used in the treatment of ulcerative colitis and the subsequent agranulocytosis was treated successfully with GM-CSF, something which has hitherto been unreported.

Growth-supporting activity for Legionella pneumophila in tap water cultures and implication of hartmannellid amoebae as growth factors.

Photosynthetic cyanobacteria, heterotrophic bacteria, free-living amoebae, and ciliated protozoa may support growth of Legionella pneumophila. Studies were done with two tap water cultures (WS1 and WS2) containing L. pneumophila and associated microbiota to characterize growth-supporting activity and assess the relative importance of the microbiota in supporting multiplication of L. pneumophila. The water cultures were incubated in the dark at 35 degrees C. The growth-supporting factor(s) was separated from each culture by filtration through 1-micron-pore-size membrane filters. The retentate was then suspended in sterile tap water. Multiplication of L. pneumophila occurred when both the retentate suspension and the filtrate from either culture were inoculated into sterile tap water. L. pneumophila did not multiply in tap water inoculated with only the filtrate, even though filtration did not reduce the concentration of L. pneumophila or heterotrophic bacteria in either culture. Growth-supporting activity of the retentate suspension from WS1 was inactivated at 60 degrees C but unaffected at 0, 25, and 45 degrees C after 30-min incubations. Filtration experiments indicated that the growth-supporting factor(s) in WS1 was 2 to 5 micron in diameter. Ciliated protozoa were not detected in either culture. Hartmannellid amoebae were conclusively demonstrated in WS2 but not in WS1. L. pneumophila multiplied in tap water inoculated with the amoebae (10(3)/ml) and the 1-micron filtrate of WS2. No multiplication occurred in tap water inoculated with the filtrate only. Growth-supporting activity for L. pneumophila may be present in plumbing systems; hartmannellid amoebae appear to be important determinants of multiplication of L. pneumophila in some tap water cultures.

A myelodysplastic syndrome with eosinophilia associated with a break in the short arm of chromosome 16.

A case is reported of a young man with cardiomyopathy and myelodysplasia with bone marrow and peripheral blood eosinophilia. Cytogenetic investigation revealed a (5;16) (q33;p13) translocation. This is the first report of myelodysplasia with eosinophilia associated with a break in 16p13 alone, with no abnormality of 16q22.

Iron granules in plasma cells.

The curious and unusual finding of coarse iron granules in marrow plasma cells is reported in 13 patients, in whom the finding was incidental. In 10 of these patients there was known alcohol abuse and serious medical complications of that abuse. Previous reports of the finding are reviewed. Haematological data of the 13 patients are presented. A hypothesis is outlined which may account for the finding.

Effect of ruminal lactic acid-utilizing bacteria on adaptation of cattle to high-energy rations.

Heifers, unadapted to a concentrate ration, were intraruminally inoculated (1 dose) with cultures of ruminal lactic acid-utilizing bacteria or with ruminal fluid from a steer adapted to a concentrate ration. Inoculation with cultures (1 L) of Selenomonas ruminantium or Megasphaera elsdenii did not produce better average daily weight gains or feed efficiency of heifers fed a high-energy ration for 21 days, if these values were compared with the performance of noninoculated heifers. Average daily weight gain and feed efficiency of heifers inoculated with 1 L of Peptococcus asaccharolyticus culture or with 1 L of adapted ruminal fluid and fed a high-energy ration for 21 days were better if these values were compared with the performance of noninoculated heifers.

Preparation of infectious cell-free herpes-type virus associated with Marek's disease.

Cell-free transmission of the herpes-type virus of Marek's disease was obtained by demineralized water treatment of infected chick embryo fibroblasts.