Intermittent 2-hour intravenous infusions of 2-chlorodeoxyadenosine in the treatment of 110 patients with refractory or previously untreated B-cell chronic lymphocytic leukemia.

The purpose of our study was to determine the effectiveness of 2-CdA in 2-hour intravenous infusions in the treatment of B-CLL. One hundred and ten patients with B-CLL received 1 to 10 courses of 2-CdA (median 2.5) at a dosage of 0.12 mg/kg daily for 5 consecutive days. Eighteen of them were untreated and 92 relapsed or became refractory to previous therapeutic modalities. Complete remission (CR) was achieved in 8 (7.3%) and partial remission (PR) in 35 patients (31.8%) giving an overall response rate of 39.1%. In 3 patients, cross-resistance to fludarabine was noticed. Toxic effects of 2-CdA were more frequently observed in previously treated patients. Hemorrhagic complications due to drug-induced thrombocytopenia were noticed in 25 (22.7%) and severe infections including sepsis in 14 (12.7%) patients.

[Autoimmune thrombocytopenia in pregnant women: diagnosis, treatment and prevention of complications in children]. / Autoimmunologiczna maloplytkowosc u kobiet w ciazy: rozpoznawanie, leczenie, zapobieganie powiklaniom u dzieci.

9 pregnancies (in 6 women) complicated by autoimmune thrombocytopenia were studied. Corticosteroids and/or azathioprine and/or intravenous immunoglobulins (IgG i.v.) were administered to 5 women during pregnancy. 1 complete remission (CR) was achieved after 3 mo. of treatment by corticosteroids and azathioprine. In peripartum period the treatment was administered in 7 cases (corticosteroids, IgG i.v., platelet transfusion). There were no haemorrhagic complications during peripartum period (8 vaginal delivery, 1 cesarean section). In 3 of 5 examined cases IgG antiplatelet antibody was detected. Study group was to small to define the correlation between level of antiplatelet antibodies and neonatal thrombocytopenia. 10 infants were born. 4 infants (including siblings) were found to have normal platelet counts immediately after delivery. They mothers were treated by IgG i.v. in 2 cases and 1 women in CR at the time of delivery. 4 infants were thrombocytopenic but required no treatment. Duration time of thrombocytopenia was 1 to 4 weeks. In these cases mothers were treated only by corticosteroids or had no therapy.

[Cyclosporin in the treatment of idiopathic aplastic anemia]. / Cyklosporyna w leczeniu samoistnej niedokrwistosci aplastycznej.

Five patients with aplastic anemia were treated with cyclosporine A. In four cases a positive response was noted. In three out of these patients frequency of blood transfusions was decreased. Platelet count increased to 50 x 10(9)/L in two cases and in one case agranulocytosis disappeared. Synergistic effect of cyclosporine A with oxymetholone and prednisone was seen. In one case an improvement lasted only for 1 year. Hepatotoxicity being a complication of therapy was noted in one patient.

[Anti-S antibodies in autoimmune hemolytic anemia]. / Autoprzeciwciala anty-S w przebiegu niedokrwistosci autoimmunohemolitycznej.

21 year old female with severe symptoms of AIHA developed twice acute haemolytic reactions at the time of blood transfusions compatible in ABO and Rh blood group systems as well as in K antigen, but incompatible by cross-match due to the presence of autoantibody in her serum. High-affinity IgG autoantibody of an unusual anti-S specificity firmly blocked S determinants on the patient red cells. S negative blood was well tolerated. Utero-vaginal infection by human papilloma virus which might have been the cause of AIHA was detected. Long-lasting steroid therapy and specific treatment of infection improved the clinical condition. The patient was under observation for 20 months. Anti-S autoantibody was being detected in the period of 18 months. Then, very weak anti-U autoantibody appeared.

Unusual gastrointestinal complications of interleukin-2 therapy.

Minor and reversible gastrointestinal side effects are common when patients receive interleukin-2 (IL-2) with or without lymphokine-activated killer (LAK) cells. We treated 42 cancer patients with IL-2 therapy and 3 patients developed serious gastrointestinal problems during treatment. Complications included sigmoid colon perforation, ischemic necrosis of the small and large intestine, and diffuse bowel ulceration. These were not associated with tumor implants or hypotension. Two patients died as a direct result of these problems despite aggressive surgical and medical management. The incidence of major gastrointestinal complications with IL-2 therapy may be greater than previously reported and a heightened awareness of potential gastrointestinal problems may circumvent considerable morbidity and mortality.

Haemodynamic effects of recombinant interleukin-2 administered by constant infusion.

Adoptive immunotherapy with recombinant interleukin-2 (rhIL-2) has been reported to induce tumour regression in some patients with refractory cancer. However, the cardiovascular toxicity of bolus therapy requires invasive monitoring of patients in the intensive care unit (ICU). In an effort to examine the haemodynamic alterations caused by a constant infusion of IL-2, as opposed to bolus therapy, we studied the haemodynamic variables of 10 patients, with no evidence of heart disease, receiving 3 x 10(6) IU/m2 per day of rhIL-2 as a continuous infusion for 5 days. Measured and derived haemodynamic variables were obtained immediately prior to, at 2, 24, and 48 h during, and upon termination of the infusion. There was no evidence of clinical haemodynamic instability in these patients. Except for development of fever and tachycardia, there were no clinically significant differences in any measured or derived haemodynamic parameter. Moreover, continuous electrocadiographic monitoring of these patients during the infusion did not reveal any abnormalities. Invasive haemodynamic monitoring in an ICU is not necessary in carefully selected patients receiving constant infusion rhIL-2, at the described dose and schedule.

[Long-term observation of patients with autoimmune hemolytic anemia]. / Wieloletnia obserwacja chorych z niedokrwistosciami autoimmunohemolitycznymi.

Forty-nine cases of idiopathic and secondary autoimmune hemolytic anaemia (AIHA) were observed. Infections developed in 64% of them before the diagnosis of the idiopathic form had been established. In 83% of the patients warm antibodies were found, and in half these cases complement activation was observed on the blood cells. In 16% of cases autoantibodies to other tissues were present as well. Higher grade of anaemia and more severe course of the disease were observed in secondary AIHA. The survival time of patients with malignant lymphoma and haemolysis developing during the proliferation phase was twice as long as in cases with simultaneously diagnosed lymphoma and haemolysis. Idiopathic AIHA was more frequent chronic and mild. During over 2 years of follow-up haemolysis regressed in 44% of cases (in idiopathic AIHA in 65% and in secondary AIHA in 19%). The followed-up group comprised 36 patients. No immediate favourable effect of splenectomy was noted. In 43% of cases infections were a complication of pharmacological treatment and (or) splenectomy. Alloimmunization against blood cells was noted in 16% of cases.

[IgM monoclonal gammopathy in plasmacytic neoplasms]. / Gammapatia monoklonalna IgM w nowotworach plazmocytowych.

In 331 patients with the diagnosis of multiple myeloma in 4 cases proliferation of plasma cells was associated with synthesis of a monoclonal IgM. In 3 of these cases coexistence was noted of features typical of multiple myeloma and Waldenström's macroglobulinaemia. In the clinical picture in two of these cases sings of blood hyperviscosity prevailed. These patients showed impairment of plasma clotting factors. The count of T and B cells in blood and the adherence and phagocytic activity of monocytes were not abnormal. The ultrastructural pattern of plasma cells in bone marrow was similar to that observed in classical cases of IgG or IgA multiple myeloma. In one case of lymphoplasmocytic proliferation with leucocytosis over 100 x 10(9)/l immunoelectroscopic examination of bone marrow cells demonstrated a formidable accumulation of the heavy chain of mu immunoglobulin in the cytoplasm of lymphoplasmacytes. In the serum and urine no monoclonal protein was found. In this case compression of vertebral bodies Th7 and L2 occurred.

[Analysis of pregnancy, labor, child development and disease course in women with Hodgkin's disease]. / Analiza ciaz, porodów, urodzonych dzieci i przebiegu choroby u kobiet chorych na ziarnice zlosliwa.

Twenty pregnancies were observed in 16 women with Hodgkin's disease. During 3 pregnancies cytostatic treatment was given. In 6 cases the disease was diagnosed in pregnancy and the treatment was started after labour. Eleven pregnancies were diagnosed during remission, after a mean period of 4 years (range: 6 months to 8 years) from the completion of treatment. All pregnancies had a normal course and labours were not complicated. In 2 cases of successive pregnancies disease recurrence developed. in 1 case the active disease was exacerbated. Twenty healthy babies were born, in one low birth weight was noted. The development of all children in a period of 6 years, on average, was normal.

Frequency response of the peripheral sampling sites of a clinical mass spectrometer.

Mass spectrometers are used in ICUs and ORs to measure the concentration of medical and anesthetic gases gathered from multiple sites. This investigation was designed to determine the accuracy of a clinical system, which included 12 ICU bedside stations monitored by a medical mass spectrometer (Perkin-Elmer RMS III, Pomona, CA). Each site station was connected to the analyzing unit via two Teflon tubes, one permanently installed, 30-m long, and the second disposable, 2.4-m long. A gas mixture containing 95% O2 and 5% CO2, alternating with room air, was delivered to a solenoid valve and from there to the connecting tubes. Gas flow-rate, delay time, rise time, and peak and trough concentrations were determined for each gas at solenoid cycling frequencies of 25, 50, and 100/min. After the first set of measurements, the 30-m tubes were thoroughly cleaned and all measurements repeated. In addition, the authors also measured CO2 delay and rise times when the gas was delivered to the mass spectrometer through an unused 30-m tube or a new 2.4-m tube. Gas flow-rate increased from 143 +/- 12 ml/min (mean +/- SD) to 238 +/- 9 ml/min after the tubes were cleaned. Delay time was identical for all gases at all solenoid cycling rates but decreased significantly (P less than 0.05), from 11.5 +/- 0.3 to 4.8 +/- 0.7 s after the ceiling tubes were cleaned. As solenoid valve rate increased, the difference between measured and actual gas concentration increased. The lowest accuracy was 63.6 +/- 2.1%, for CO2 at 100 cycles/min.(ABSTRACT TRUNCATED AT 250 WORDS)

[Results of the treatment of patients with advanced Hodgkin's disease by the ABDiC and/or BVCPP protocols]. / Wyniki leczenia programami ABDiC i/lub BVCPP chorych w zaawansowanym okresie ziarnicy zlosliwej.

In 22 patients with phase IV of Hodgkin's disease refractory to treatment by the programmes MOPP and/or CVPP, and ABCD and/or BACOP, and in patients with recurrences after this treatment the ABDIC and/or BVCPP programmes were applied. In 5 cases this treatment was associated with radiotherapy. Complete remission lasting 30 months was achieved in one case. In 9 cases only clinical improvement was noted. Twelve patients failed to respond to this treatment. Ten patients died. The mean survival time of all patients from the beginning of treatment by ABDIC and BVCPP programmes to the end of the observation was 14 months, and the time from the diagnosis to the end of the observation was 69 months. The results of this treatment are not satisfactory.

[Clinical analysis of 15 cases of T-cell malignant lymphoma in adults]. / Analiza kliniczna 15 przypadków chloniaka zlosliwego t--komórkowego u osób doroslych.

In the years 1981-1987 T-cell lymphoma was diagnosed in 7 women and 8 men (2.2% of all hospitalized cases of malignant lymphomas). Chronic lymphatic and prolymphocytic leukaemias and T-zone lymphomas prevailed. In most cases systemic symptoms and lymphadenopathy were characteristic features. In 6 cases cutaneous changes coexisted having the appearance of desquamative erythema, in 2 cases cutaneous changes preceded by 10 years the generalization of the process. In 10 cases other organs were involved. Absolute lymphocyte count ranged from value below normal to values above normal range. In 8 cases hypergammaglobulinaemia was present. The results of treatment were bad. Early drug-induced myelosuppression was observed. Nine patients died. In the group of lymphoblastic lymphoma and Pinkus lymphoma all 5 patients died.

An automated mechanism for protection of mass spectrometry sampling tubing.

The usefulness of medical mass spectrometers in intensive care units can be limited by too frequent obstruction of the tubing that transports gases from the patients to the analyzing unit. To overcome this problem, we developed an automated system consisting of an infrared light sensor and a three-way valve. One port of the three-way valve connects to 2.4-m disposable tubing that collects gases from the patient's airway. The second port is connected to a mass spectrometer analyzing unit through 30-m permanently installed tubing. The third port is connected to a pressurized oxygen source. An infrared light sensor is placed on the shorter tubing, between the patient and the three-way valve. When increased optical density is detected, due to entrainment of respiratory secretions, the three-way valve is activated. Gas flow is closed between the patient and the mass spectrometer and opened between the pressurized oxygen source and patient tubing to flush its contents. During the six years that the protection system has been in use, the frequency with which the disposable gas collection tubing is changed has been halved. Furthermore, periodic tests of delay and response times, performed at each bedside station, indicate that permanent connection tubing only needed cleaning at 2- to 3-year intervals. The system has decreased the cost of operating our mass spectrometers while also reducing periods of unavailability due to equipment failure.

Capnography in mechanically ventilated patients.

Capnography, the science of CO2 waveforms analysis, can play a role in the management of mechanically ventilated patients. Mass spectrometers are the devices most commonly used to collect sequentially and examine CO2 waveforms from multiple patients in the ICU or operating rooms. We present here a review of some clinical and technical problems, which may be resolved efficiently and expeditiously through the use of mass spectrometry and capnography. Mechanical failures, especially those that lead to rebreathing of exhaled gases, can be readily detected. The patient's progress during weaning and the consequences of changes in mechanical assistance can be virtually and noninvasively determined. An expanded role of capnography in mechanically ventilated patients can increase the use of mass spectrometers in the ICU.

Life-threatening fluid and electrolyte abnormalities associated with cancer.

This article reviews the life-threatening fluid and electrolyte abnormalities that develop in association with, or as a result of neoplasms or their therapy. Ectopic hormone secretion by tumors and their resultant electrolyte aberrancies are also discussed. The emphasis of this article is on clinical phenomena encountered in the ICU that are specific to cancers and their therapy rather than being a review of electrolyte abnormalities in general. Each topic includes a discussion of the management of the abnormality.