Report on slide session, British Society for Haematology, 43rd Annual Scientific Meeting, Glasgow, 2003.

Seven patients who had a diagnostic problem were presented at the British Society for Haematology, Annual Scientific Meeting in 2003. The likely diagnosis was discussed on the basis of a synopsis of the history and blood film and trephine biopsy features and forms the basis of this report. Diagnostic problems dealt with included lymphoproliferative and myeloproliferative disorders and haemolytic anaemia.

Percutaneous insertion of subclavian Hickman catheters.

We have assessed the percutaneous insertion of Hickman catheters implanted directly into the subclavian vein; 116 catheters were inserted in 86 patients. The catheters were all inserted by members of the haematology staff. The majority of the catheters were inserted under local anaesthetic in a haematology ward with filtered positive pressure ventilation. X-ray screening was not routinely used. The average patient age was 45 years and the average platelet count was 155 x 10(9)/l. Sixty-seven per cent of the catheters either remain in situ or have been removed electively or at death. The remainder have been removed for a variety of reasons (infection 10%, suspected infection 8%, accidental dislodgement 7%, thrombosis 4%, catheter blockage 3%, catheter fracture 0.9%). The only complication specific to direct subclavian puncture was pneumothorax (4%). This disadvantage may be offset by rapid insertion, a cosmetically superior result and the avoidance of surgical and operating theatre time.

Mitoxantrone, Etoposide and Prednisolone-a Novel Combination in The Treatment of Relapsed and Refractory Lymphoma.

A new combination chemotherapy comprising mitoxantrone 10 mg/m(2) iv on day 1, etoposide 100 mg/m(2) iv/po days 1 to 3 and prednisolone 25 mg/m(2) days 1 to 10 was assessed in the treatment of 18 patients with relapsed or refractory Hodgkin's disease or non-Hodgkin's lymphoma. An overall response rate of 74% was achieved. Complete remission occurred in 41% and partial remission in a further 33% of patients. Toxic effects were limited and the regime suitable for out-patient administration. Treatment delays were few and due principally to mild haematological toxicity.

The relationship between number of interphase nors and nor-bearing chromosomes in non-Hodgkin's lymphoma.

The ribosomal genes (located on the acrocentric chromosomes 13-15, 21-22) may be identified by their silver stained gene products, i.e. NOR related proteins. The NOR bearing chromosome activity can be observed at metaphase with the potential for all ten chromosomes to be positively stained. On the other hand, during interphase they fuse so that eventually only a single silver positive structure is seen in resting normal cells. Investigations of histopathological sections of non-Hodgkin's lymphoma (NHL) have demonstrated a correlation between the numbers of interphase NORs and the grade of tumour. There is generally a higher number of interphase in high-grade, and a lower number in low-grade tumours. This histopathological and cytogenetic study of 13 patients with NHL shows that the higher numbers of interphase NORs in the high-grade tumours is not necessarily a reflection of increased numbers of NOR-bearing chromosomes. Examples were found of high-grade neoplasms, showing the expected high numbers of interphase NORs, but not an increased number of NOR-bearing chromosomes. Conversely, some low-grade tumours, with the expected low number of interphase NORs, had increased numbers of NOR-bearing chromosomes. Our conclusion is that the interphase NOR number is related to factors other than chromosome numbers. We suggest that NOR numbers at interphase may be related to cell turnover. This is supported by previous investigations using DNA flow cytometry and the monoclonal antibody Ki67.