Prevalence and Types of Anemia and Associations with Functional Decline in Geriatric Inpatients.

BACKGROUND: The prevalence of anemia in hospitalized seniors has been linked to poor functional outcomes, increased mortality, and longer hospital stays, and has been associated with advancing age, male sex, and cognitive impairment. Despite the potential for complications, anemia often is undiagnosed and/or untreated in seniors. OBJECTIVES: Examine (a) the distribution of anemia diagnosis and treatment in patients in a rehabilitation hospital, and (b) patients' cognitive and functional outcomes. DESIGN: Retrospective chart review of medical records of 132 patients. MEASUREMENTS: The presence and type of anemia were determined based on the World Health Organization criteria for adults and Smith's algorithm, respectively. The Mini-Mental State Exam (MMSE) was used to measure cognitive status. Functional impairment was assessed using the Functional Independence Measure (FIM). RESULTS: The mean age of the sample was 82.20 years, with 68% being female, the mean MMSE and FIM scores were 23.95 (SD = 4.3) and 82.82 (SD = 15.63), respectively. In total, 67% of males and 46% of females were anemic (P < 0.05). The majority of anemias were caused by nutritional deficiencies. The percent of anemic females receiving treatment for anemia was higher (71%) than the percent of anemic males (46%) (P < 0.05). The majority of the patients improved functionally regardless of anemia status. CONCLUSIONS: Results indicated that a substantial number of patients in a geriatric hospital were anemic, with significant percentage going untreated. The overall improvement in patients' functional abilities suggests that remedial rehabilitation of frail seniors has an impact on recovery during their hospital stay.

"Pseudoneoplastic" leprosy. Leprosy revisited.

A 70-year-old Italian man with a history of squamous cell carcinoma of the lung presented with a nodular skin eruption. He had traveled extensively in India and Sri Lanka. The nodules were well demarcated and measured up to 3.5 cm in diameter. Histologically, there was a proliferation of spindled and polygonal cells with focal and relatively inconspicuous cytoplasmic vacuolation. A macrophage-monocyte lineage for the cells was confirmed by paraffin section immunohistochemistry, using the monoclonal antibodies anti-CD45, MAC-387, KP-1, UCHL-1, MT-1, L26, and MB2. Infiltrating borders, extension of the lesion into the subcutis, and involvement of small dermal nerves and eccrine glands initially suggested the possibility of a "histiocytic" neoplasm of indeterminate biological potential. However, air-dried and Giemsa-stained material from a fine-needle aspirate of one cutaneous nodule showed needle-shaped intracellular "negative images," and acid-fast stains revealed a large number of intracytoplasmic bacilli in virtually all of the vacuolated lesional cells. Furthermore, a second skin nodule that was excised 3 weeks after initial presentation showed the typical morphology of lepromatous leprosy. The clinicopathologic features of this case demonstrated several similarities with those of so-called "histoid" leprosy. Unusual morphologic variants of leprosy need to be considered in the interpretation of unusual "histiocytic" infiltrates in order to avoid a mistaken diagnosis of neoplasia, regardless of the geographic locale in which the patient is evaluated.

Immunoreactivity for bcl-2 protein in cutaneous lymphomas and lymphoid hyperplasias.

The B-cell leukemia/lymphoma gene (bcl-2) produces a unique protein product (BCLP) that is believed to protect lymphoid cells from apoptosis. The bcl-2 gene is frequently rearranged in nodal follicular lymphomas as well as in diffuse lymphoproliferations, but has generally been regarded as most useful in the recognition of the former of these lesions. However, little is known regarding BCLP expression in cutaneous lymphoid infiltrates. Using an immunohistochemical technique and a monoclonal antibody (clone no. 124) the authors examined 67 examples of cutaneous lymphoid infiltrates--31 cases of malignant lymphoma of the skin (MLS) and 36 examples of cutaneous lymphoid hyperplasias (CLH)--to determine if patterns of BCLP reactivity could distinguish CLH from MLS or primary from secondary involvement of the skin by malignant lymphoma. Fifty-eight per cent of MLS cases were BCL-positive, as were 33% of CLH. Three of four cases of follicular cutaneous lymphoma showed BCLP-positivity in neoplastic follicles, whereas similar structures in cases of CLH with a follicular pattern were BCLP-negative. Sixty per cent of primary MLSs and 57% of secondary lymphomas were reactive for BCLP. These data suggest that immunostains for BCLP are of little help in the separation of benign from malignant cutaneous lymphoid infiltrates, and that they are likewise incapable of separating primary from secondary MLS. BCLP immunostains may have a limited adjuvant diagnostic role in distinguishing reactive from neoplastic follicular lymphoid lesions of the skin.

Human subcutaneous pythiosis.

Two cases of subcutaneous infection caused by the primitive aquatic hyphal organism Pythium are described. Pythium is an important pathogen of horses in the U.S.A. and Australia. Cases of human subcutaneous pythiosis have been cited in the literature, but clinical and histopathological features have not been described previously. Both cases occurred in young immunocompetent males in the periorbital region and showed rapid growth, clinically mimicking a tumor and requiring operative biopsy. In both cases there was a history of exposure to either swampy water or horses. The tissue reaction was distinctive, closely resembling that seen in equine pythiosis, comprising well-defined granular eosinophilic islands bordered by macrophages, multinucleate giant cells, fibrosis and numerous eosinophils. Hyphae were well demonstrated with the Grocott stain but only poorly with the PAS method. Identity of the organisms was confirmed with an immunoperoxidase technique employing a polyclonal antiserum to Pythium. Both patients responded well to amphotericin B.

Metastasis of pineal germinoma via ventriculoperitoneal shunt.

The case of a 13 year old boy with pineal germinoma and subsequent metastasis 3 years later via ventriculoperitoneal shunt to the abdominal cavity is presented. The abdominal disease was managed with chemotherapy and subsequent surgical resection. He remains free of disease 2 years following the resection. The literature regarding this rare complication is reviewed.