Megakaryoblastic micromegakaryocytic crisis in chronic myeloid leukemia.

Atypical megakaryoblasts (MKB) or megakaryocytes (MK) are occasionally present in the peripheral blood during the terminal development of chronic myeloid leukemia (CML). We report on a 49-year-old female suffering from Ph1 chromosome-positive CML with typical megakaryoblastic transformation in the peripheral blood and in the bone marrow. The small "blasts" were at the most only slightly larger and were occasionally even smaller than lymphocytes but showed megakaryoblastic or atypical megakaryocytic differentiation. The cytoplasmic cytochemical pattern of the atypical megakaryocytic cells was identical to that of large atypical thrombocytes. Platelet peroxidase was detected upon electron-microscopic (EM) examination. Immunologic characterization disclosed the presence of MK-specific antigens. When cultured in vitro on agar, the blasts transformed spontaneously into large mature MK, exhibiting characteristic cytochemical and immunological patterns. Cytogenetic examination of peripheral blood showed severe abnormalities. The patient did not respond to therapy and died 3 months after manifestation of the blast crisis.

Myoglobinemia in the early phase of acute myocardial infarction.

Close-meshed determinations of plasma myoglobin, creatine kinase, and its isoenzyme MB were carried out in nine patients admitted to the clinic less than 4 hours after the onset of symptoms in the course of acute myocardial infarction (AMI). Myoglobin clearly appears earlier (mean 2 hours and 30 minutes) in the plasma than creatine kinase (mean 4 hours and 15 minutes) and isoenzyme MB (mean 5 hours and 30 minutes after the onset of symptoms). During the first hours of AMI plasma myoglobin shows multiple peaks in all patients. Because this pattern is observed only with myoglobin but not with creatine kinase, it appears that myoglobin mirrors the early course of the necrosis more distinctly than creatine kinase. Plasma myoglobin was also found elevated after intramuscular injections and a high voltage accident. Myoglobinuria was not detectable after myocardial infarction.

[Rhabdomyolysis with acute kidney failure after heroin poisoning]. / Rhabdomyolyse mit akutem Nierenversagen nach Heroin-Intoxikation.

A 24-year-old man who had been a drug addict for years, was admitted to hospital having been unconscious for several hours after injecting an overdose of heroin. He was in acute renal failure with extensive swelling of soft tissues of the right upper leg and right buttock without external signs of injury. The swelling rapidly extended to both right limbs, trunk and external genitalia. The clinical suspicion of rhabdomyolysis was confirmed by a high level of serum myoglobin (1570 mg/ml), and in a gluteus maximus muscle biopsy. The acute renal failure caused by the rhabdomyolysis was reversible after a short period of haemodialysis and, after decompression fasciotomy of the affected muscles, there were no severe sequelae. In view of the good prognosis with early diagnosis an exact clinical examination (observation of soft tissue swelling and dark urine) is of great importance in case of heroin addiction and/or poisoning.

[Is cardiac monitoring required after electrical injuries? (author's transl)]. / Nach Elektrounfall: kardiale Uberwachung?

Professional or spare time contacts with electrical appliances are, due to careless handling or technical inadequacies, potentially always associated with electrical injuries. The effects of the electric current on the body depends mainly on voltages: skin and muscle lesions predominate in high voltage injuries. Out of 23 patients, 19 with electrical injuries and 4 with lightning accidents, 18 showed normal ECGs at the time of hospital admission. There were no changes at follow-up. The remaining 5 patients had cardiac arrhythmias which disappeared after 1 1/2 to 36 hours using bedrest and symptomatic treatment only. Cardiac longterm monitoring is thus not required after electrical injuries.

[Clinical and electrophysiological observations in a case of Romano-Ward syndrome ]. / Klinische und elektrophysiologische Beobachtungen bei Romano-Ward-Syndrom.

Syncope associated with atypical ventricular tachycardia of the "torsades de pointes" type was observed in a 16 year-old girl with hereditary QT prolongation. The arrhythmia occurred only during maximal prolongation of the QTc to 0.77 sec, which had possibly been aggravated by exercise and hypokalaemia. Electrophysiological studies were performed when the QTc was 0.59 sec. Incremental as well as premature ventricular pacing with single or double premature ventricular beats did not initiate ventricular arrhythmias, but revealed AV nodal and bundle branch reentry. It is postulated that these types of macroreentry are involved in the twisting of the QRS complexes in the surface ECG in torsades de pointes.

[Plasma filtration treatment in thyreotoxic crisis]. / Plasmafiltrationsbehandlung einer thyreotoxischen Krise.

A 65-year-old man was treated three times in 4 consecutive days with plasma filtration for a severe thyroid storm. During the treatment the serum and filtrate levels of thyroxine, triiodothyronine, free T4, free T3, TBG, albumin and reverse-T3 were measured, and the results showed that, apart from reduction of the total hormone amount, the supply of binding sites for the free hormones is an important aspect in the treatment of thyroid storm.