Fibrinolytic capacity in hemodialysis patients treated with recombinant human erythropoietin.

A major adverse effect of recombinant human erythropoietin (r-HuEPO) in hemodialyzed patients are thrombotic events. Several reports on platelet function during r-HuEPO treatment have been published but less is known about fibrinolysis. In the present study, the fibrinolytic capacity was studied in 20 patients on maintenance hemodialysis and treated with r-HuEPO. The patients were randomized into two groups and investigated in a crossover design. r-HuEPO was administered intravenously and subcutaneously in each group and was given for 3 months, respectively. Plasma tissue plasminogen activator (t-PA) and released t-PA remained unaffected by r-HuEPO in both groups throughout the study. Tissue plasminogen activator inhibitor (PAI) increased in a cyclic way reaching peak values 4-6 weeks after the start of investigation and again 4-6 weeks after changing therapy. The increase in PAI was significant in the two groups (0.025 > p > 0.01). Tissue plasminogen antigen was low in the uremic patients. The influence of r-HuEPO on this parameter was not investigated. Compensatory changes in plasma levels of factor XII procoagulant activity, activated protein C and of alpha 2-antiplasmin were not observed. Thrombotic events occurred in 4 patients at peak values of PAI. Six patients required an increase in heparin dose simultaneously with the increase in PAI. Thus, r-HuEPO seemed to affect the fibrinolytic capacity of uremic patients.

The effect of L-glutamine and sodium intake in cystinuric patients.

Four patients with cystinuria were studied to assess the effect of L-glutamine and sodium on the urinary excretion of dibasic amino acids. L-Glutamine 2.1 g/d and sodium about 300 mmol/d were given for three weeks, after which L-glutamine 2.1 g/d and sodium about 150 mmol/d were given for a further three weeks. L-Glutamine reduced the excretion of dibasic amino acids in one patient with both sodium regimens, but not significantly. In the remaining three patients no reduction was observed.

Extramedullary solitary plasmocytoma at the uterine cervix as a cause of postcoital bleeding.

A 34-year-old woman with postcoital bleeding due to an extra-medullary solitary plasmocytoma at the uterine cervix is presented. The condition is very rare--only 4 cases have been described in the literature. The patient was treated with conization, and no sign of local recurrence or generalized disease appeared during a 3-year follow-up period.

Low-dose cytosine arabinoside therapy in a patient with myelofibrosis during transformation to acute non-lymphocytic leukemia.

A patient with myelofibrosis transforming into acute non-lymphocytic leukaemia (ANLL) was treated with low doses of cytosine arabinoside (ARA-C). Complete remission was obtained twice without serious toxicity. It is suggested that low-dose ARA-C may be an effective and rather non-toxic therapy in patients with myeloproliferative disorders transforming to ANLL.

Low dose cytosine arabinoside in the treatment of acute non-lymphocytic leukaemia.

Complete remissions were obtained with low dose cytosine arabinoside (ARA-C) in 8 of 21 previously untreated patients with ANLL above 60 years of age and in 2 of 4 previously treated patients below 60 years of age. 7 of the patients remain in remission after 1-26 months. The results demonstrate that low dose ARA-C with rather low toxicity may induce remissions in elderly patients with ANLL.

Relationship between angiotensin-converting enzyme and lysozyme in sarcoidosis.

The relationship between serum angiotensin-converting enzyme (SACE) and serum lysozyme (SLZ) was examined in 48 patients with sarcoidosis. The level of at least one enzyme was elevated in all 41 cases with active sarcoidosis; both enzymes were elevated in 24. SACE and SLZ were positively correlated. The elevation of SLZ or SLZ+SACE was most frequent in patients with pulmonary parenchymal involvement or extrathoracic manifestations. Both enzymes are suitable for disease monitoring, but in most cases the more specific SACE must be preferred as a measure of disease activity, although SLZ seems to be a little more sensitive. Blood for SACE analysis must arrive at the laboratory not later than 3 days after blood collection in order to avoid enzyme inactivation.

Alterations in plasma antithrombin III following total hip replacement and elective cholecystectomy.

Antithrombin III activity and immunoreactive antithrombin III was determined in 31 patients before elective surgery and 3 h, 1, 3 and 7 d after. The values fell about 10--20% from 3 h to 3 d, but had returned to preoperative levels by the seventh day. A fall to 40% was seen. The fall in activity was a little smaller than the fall in immunoreactive protein.

Outpatient sputum cytology in the diagnosis of lung cancer.

The objective of the present survey was to show whether outpatient sputum examination for malignant cells gives sufficient material suitable for diagnostic purposes. The results of 1031 sputum cytological examinations carried out in 767 patients over a 30-month period are presented. Three hundred and two (29.3%) specimens were unsuitable. Initial examinations revealed 17 with clearly malignant changes in 15 patients, and 23 with suspected malignancy in 14 patients. Examination of new specimens in these 14 patients revealed a further four tumors. Of the 19 patients diagnosed as having lung carcinoma five were operated upon. Three of these five were diagnosed cytologically although they had normal chest X-ray pictures.