Renal trapping of In-111 troponolate labeled platelets in thrombotic thrombocytopenic purpura.

A patient with active thrombotic thrombocytopenic purpura underwent examination with In-111 troponolate labeled autologous platelets. A mean platelet survival of 1.2 days was found, comparable to formerly described studies using other methods. Furthermore, remarkable renal uptake of radioactivity consistent with abnormal platelet trapping was demonstrated. In the absence of any other signs of renal involvement, the conclusion was reached that the platelet scan is a sensitive and direct method for showing renal involvement in thrombotic thrombocytopenic purpura.

[Angioedema caused by enalapril]. / Angio-oedeem ten gevolge van enalapril.

Since 1984 25 cases of enalapril induced angioedema have been reported to the Netherlands Center for Monitoring of Adverse Reactions to Drugs. Two patients with enalapril induced angioedema are described. The pathophysiological mechanism of this potentially life-threatening adverse effect is probably not a direct allergic response to the drug itself. Enalapril inhibits angiotensin converting enzyme, which not only metabolizes angiotensin I but also bradykinin and 'substance P'. Bradykinin and 'substance PH may then accumulate and cause angioedema in a direct or indirect way. It is of great importance that instances of oropharyngeal swelling are considered a possible result of an adverse reaction to ACE-inhibitors.

Some effects of combination chemotherapy with cis-platinum on renal function in patients with nonseminomatous testicular carcinoma.

Renal function in 24 patients with disseminated nonseminomatous testicular carcinoma treated with combination chemotherapy including cis-platinum was examined prospectively. Renal function was monitored by several determinations of glomerular filtration rate (GFR), effective renal plasma flow (ERPF) and serum creatinine, and beta-2-microglobulin. A reduction in GFR and ERPF was found at the end of the induction chemotherapy and at six weeks thereafter. Median GFR and ERPF decreased both 23% (P less than 0.01). Serum creatinine and beta-2-microglobulin concentrations however did not rise. It is suggested that under the influence of chemotherapy with platinum the production of creatinine and beta-2-microglobulin is decreased rendering their serum levels unsuitable as parameters of renal function.

In-111 leukocyte scanning and partial functional asplenia in a patient with Sézary syndrome.

Functional asplenia is described in the case report of an 80-year-old woman who was admitted with Sézary syndrome. The spleen could not be visualized by a Tc-99m tin colloid (SnC) liver and spleen scan, but was visualized by a Tc-99m sulfur colloid (SC) scan, suggesting a different mechanism in accumulation of SnC and SC in the spleen. In-111 oxine labeled Sézary cells could be found in the spleen, bone marrow, and lymph nodes.

Tumor markers in patients with non-seminomatous germ cell tumors of the testis.

In 82 patients with non-seminomatous germ cell tumors, the levels of alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG) and lactate dehydrogenase (LDH) were determined to find if there was a relation to clinical stage. Only two out of 34 patients could be restaged as a result of the presence of elevated marker levels. Markers were present in 12% of patients with stage IIA, 67% with stage IIB and 85% with stage III. In contrast to HCG, the initial levels of LDH and AFP were related to tumor stage. A return of marker levels to normal during chemotherapy always meant tumor regression and indicated complete remission in 42% of patients. Initial marker levels did not correlate with the eventual destructionn of all tumor by chemotherapy. A rise in marker levels always correlated with tumor progression. In conclusion, tumor markers have only a limited value in clinical staging. Disappearance of markers during chemotherapy does not always indicate destructio of all viable tumor, probably because non-producing cell lines such as mature teratoma may persist after chemotherapy.

The value of AFP and HCG half lives in predicting the efficacy of combination chemotherapy in patients with non-seminomatous germ cell tumors of the testis.

The decline of serum levels of AFP or HCG in 26 patients with disseminated non-seminomatous germ cell tumors during chemotherapy showed two different patterns: a linear decline or an increasing apparent half life (AHL). The initial AFP half life in 13 patients with a linear decline was 7.2 +/- 1.8 days, and did not differ from the initial half life in 5 patients with a curvi-linear pattern. HCG half life was 3.0 +/- 0.5 days in 10 patients with a linear AHL, and was not different from the initial half life in 6 patients with delayed marker disappearance. Based on the half life pattern of AFP or HCG the result of chemotherapy was predicted. When AFP or HCG showed a linear decline, all viable tumor appeared to be eliminated in 38 and 40% respectively of the patients. An increasing AHL indicated the presence of active tumor, mostly mature teratoma, in 60% of the patients with AFP and in 83% of the patients with HCG. Thus, the pattern of AFP or HCG half life does not predict the eventual outcome of chemotherapy with certainty.

Embryonal rhabdomyosarcoma of spermatic cord.

This article discusses 2 patients with embryonal rhabdomyosarcoma of the spermatic cord and presents a survey of the literature and therapeutic methods. In recent years the prognosis of this malignant tumor has improved significantly by virtue of a combination of radical inguinal orchiectomy and retroperitoneal lymph node dissection with supplementary chemotherapy and/or radiotherapy.

Combination chemotherapy with cis-diammine-dichloro-platinum, vinblastine, and bleomycin in advanced testicular non-seminoma.

40 patients with disseminated testicular non-seminoma were treated with cis-diammine-dichloro-platinum, vinblastine, and bleomycin. Complete remission was achieved in 24 (60%) patients and partial remission in 11 (28%). 22 of the 24 complete responders, who have been followed-up for a median of 11 months, have been tumour-free for 5--30 months. There were 3 drug-related deaths. This regimen is the most effective remission-induction treatment available for disseminated testicular non-seminoma. Patients should be treated in centres experienced in the specialised management of this potentia-ly curable disease.

Idiopathic acquired panmyelopathy in pregnancy. A case report.

A case of idopathic acquired panmyelopathy (aplastic anaemia) in pregnancy in a 32-year-old woman is presented. The outcome for mother and child was favourable. Special attention is paid to the management of the delivery. Another aspect of interest is the haematologic status of the child. In panmyelopathy an immunologic mechanism may operate as indicated by the finding of platelet membrane associated immunoglobulins, which were also present in our patient. If the bone marrow lesions in this disease are indeed due to immunological injury, they are mediated by immune complexes or by a cellular mechanism, for it is well know that IgG antibodies may pass through the placenta and induce lysis of circulating blood cells in the newborn. There was no evidence of bone marrow damage in the infant. This is in accordance with the cases mentioned in the literature.

[Liver lesions due to long-term use of anabolic steroids and oral contraceptives]. / Leverafwijkingen bij langdurig gebruik van anabole steroïden en orale anticonceptiva

PIP: Multiple liver tumors were observed in 2 women, 14 and 30 years of age, who had taken anabolic steroids over a period of years. In one case peliosis hepatis was found. 2 patients, 24 and 34 years of age, who had used oral contraceptives (o.c.s) for 9-10 years, were also examined for liver tumors. In one patient an increased uptake of the left hepatic lobe was observed, which corrected itself after discontinuation of o.c. use. Focal nodular hyperplasia was found in the other patient. 3 types of liver tumors are distinguished: focal nodular hyperplasia, hepaticellular carcinoma, and peliosis hepatis. They can be associated with long-term o.c. use, usually in younger women. Pain and swelling are the first symptoms of such tumors, and tests show slightly elevated liver enzyme values. A diagnosis can be reached using scintigram, angiogram, or angiography. Surgery to remove the tumor is indicated in the event of bleeding.^ieng