Increased thrombin generation during fibrinogen and platelet recovery as an explanation for hypercoagulability in children with L-asparaginase therapy for ALL or NHL: a preliminary report.

Three out of 21 patients treated at the Children's Hospital of Eastern Switzerland for ALL or NHL with the respective BFM-90 protocols experienced thrombotic complications during Erwinia L-asparaginase therapy. We therefore investigated the development of the haemostatic imbalance in six children during the induction phase of both protocols. In the average, elevated thrombin generation was found simultaneously to an increase in fibrinogen, cross-linked fibrin degradation products and platelet counts between protocol days 28 to 35. This period thus seems to harbour an increased potential of hypercoagulability which could explain the accumulation of thrombotic complications described by Sutor et al. Moreover, day to day investigations just before and one day after L-asparaginase administration did not show any relevant change in the above named parameters, thus rather indicating a cumulative than a single dose effect of Erwinia L-asparaginase therapy on the coagulation system. These findings lead to the question if the prophylactic use of anticoagulants might reduce the hypercoagulability seen during L-asparaginase therapy, which is currently under investigation in our institutions.

[Diagnostic significance of lactate concentration in CSF in patients with meningitis (author's transl)]. / Diagnostische Bedeutung der Lactatbestimmung im Liquor bei Meningitis.

White-cell count and differential blood count, total protein, lactate dehydrogenase activity (E.C. 1.1.1.27) and lactate concentration were determined in 496 CSF samples, obtained by lumbar puncture. Lactate was measured with a new enzymatic test. Reference values were determined for lactate and lactate dehydrogenase (90% limits: 1.2-2.1 mmol/l and 6-26 U/l, respectively). Lactate content proved to be best in the differential diagnosis between acute bacterial and abacterial meningitis: concentrations of 3.5 mmol/ml and above were found exclusively in bacterial meningitis. As for other diseases, markedly increased lactate concentrations were measured only in patients with brain tumour or cerebrovascular disease (up to 9.3 mmol/l). Determination of lactate concentration alone would have led to a misdiagnosis of acute bacterial meningitis in 3% of cases. If the CSF contains 3.5 mmol/l lactate or more and the leucocyte cell count is above 800/microliter, brain tumour or cerebrovascular disease can be practically excluded and the diagnosis of bacterial meningitis made with a high degree of reliability.

[Contribution to central nervous system tumor diagnosis by means of cytocentrifuged cerebrospinal fluid]. / Beitrag zur ZNS-Tumordiagnostik mit Hilfe des zytozentrifugierten Liquors.

The cytocentrifugation of the liquor cerebrospinalis provides a useful diagnostic tool to differentiate benign from malign diseases of the central nervous system. The method is illustrated with liquor analyses in the field of pediatric oncology: medulloblastoma, leptomeninx sarcoma, plexuspapilloma, astrocytoma, Abt-Letterer-Siwe, ALL, reticulum cell sarcoma, Ewing sarcoma, retinoblastoma. The speed and ease of the processing, the highest possible cellular yield and the good preservation of the cellular characteristics are great advantages of this new method.