Association between chronic lymphocytic leukemia and sarcoidosis: clinical value of bronchoalveolar lavage.

We report a case of sarcoidosis, occurred in a patient with chronic lymphocytic leukemia (CLL) shortly following the completion of initial chemotherapy, who relapsed shortly after a second course. Since bronchoalveolar lavage (BAL) demonstrated a predominance of CD4+ lymphocytes, it largely excluded spread of the malignant disorder to the lung, and strongly suggested that sarcoidosis was the cause of the pulmonary infiltrates. This diagnosis was confirmed by the finding of non-caseating granuloma on transbronchial lung biopsy.

Acute intravascular haemolysis with massive microspherocytosis in a 75-year-old woman.

Acute intravascular haemolysis (AIH) sometimes occurs in patients with sepsis or bacteraemia, mainly due to clostridia or Salmonella sp., and may be a life-threatening condition. We describe a case of AIH in a 75-yr-old woman with chronic cholelithiasis. Blood and stool cultures were repeatedly negative, but the massive microspherocytosis, typically observed in clostridia infections, oriented our diagnosis. The patient was treated with antibiotics and for a rapid worsening of her conditions, which could have led to the onset of a multi-organ dysfunction syndrome (MODS), with plasma exchange and, subsequently, haemodialysis, with satisfactory results.

Satisfactory recovery and viability of stem cells cryopreserved at high cell concentration.

Peripheral Blood Stem Cells (PBSC) are being extensively used in both oncology-haematology and in solid tumor therapy schedules. The latest generation of cell separators allow the collection of greater numbers of nucleated cells (NC) than is usually obtained in bone marrow transplantation (BMT) settings. Thus, larger volumes of components would be stored if the same NC concentration employed in BMT is to be used. In order to reduce large volume DMSO-infusion related side effects and to avoid storage problems, we froze components from 23 PBSC collections at higher NC concentrations, from 40-200 x 10(6)/mL. After 2-12 months of storage, we thawed the samples and determined if the high NC concentration had a detrimental effect on NC viability and on stem cell clonogenicity. No statistically significant differences emerged in regard to CFU-GM, CFU-GEMM and BFU-E percent recovery even at 200 x 10(6)/mL NC concentration.

Cold agglutinin hemolytic anemia in a patient with adult-onset Still's disease.

We report on a patient with adult Still's disease who developed, at the onset of her illness, an autoimmune hemolytic anemia (AHA) due to cold agglutinin (CA). Hemolysis spontaneously subsided and CA disappeared before starting therapy with aspirin and prednisone. The occurrence of AHA in patients affected with collagen diseases is currently explained by a loss of tolerance, leading to the emergence of multiple autoreactive clones. In our case the self-limiting course of AHA leads us to propose another interpretation, i.e. that the cold reactive autoantibody might have been related to a transient infection able to play a pathogenetic role in the systemic disease, as suggested by several authors.

[Acute hybrid leukemia. Review of the literature and presentation of a case]. / La leucemia acuta ibrida. Rassegna della letteratura e illustrazione di un caso.

In the last years, the development of immunophenotypic and molecular analyses allowed to recognize several cases of hybrid acute leukemia (AL), whose blast cell display both lymphoid and myeloid features. Hybrid, or mixed-lineage, AL seems to have distinct clinical manifestations and hematological findings, and is mainly characterized by resistance to chemotherapy and poor prognosis. We report on a patient with AL, which showed a very rapid switch from the lymphoblastic phenotype exhibited at presentation to a myelomonoblastic one, appeared at first relapse, and lastly progressed to an undifferentiated leukemia in the terminal phase. Together with this morphologic and cytochemical evolution, leukemic cells expressed, besides the primary early-B antigens, new immunological markers related to T-lymphocytic and myeloid lineages. Based on this observation and current understanding of the ontogenesis of hematologic malignancies, we discuss biological mechanisms which are likely to underlie hybrid leukemia.

A case of Waldenström macroglobulinemia terminating in acute lymphoblastic leukemia.

A case of acute lymphoblastic leukemia occurring in a patient with Waldenström macroglobulinemia more than 6 years after the onset of the disease is reported. At the time of acute transformation, bone marrow and peripheral blood lymphoid populations were almost entirely represented by lymphoblasts; the serum monoclonal peak had disappeared and no cells bearing surface or intracytoplasmic immunoglobulins were found. This observation suggests that the blast crisis might be derived from a dedifferentiative process within the lymphatic clone of the chronic phase.

Effect of combined use of intravenous salbutamol and aminophylline on cardiac rhythm in chronic obstructive lung disease.

The effect on cardiac rhythm of intravenous administration of salbutamol during prolonged aminophylline infusion was evaluated by means of ECG Holter monitoring in 20 patients with chronic obstructive lung disease (COLD) without respiratory failure. Data were compared with a baseline 24-hour Holter monitoring during which an individual arrhythmia pattern was established for each patient. Intravenous administration of aminophylline with fast achievement of therapeutic plasma levels, has a variable and nonsignificant influence on supraventricular arrhythmias, whilst a statistically significant increase of premature ventricular contractions (PVCs) has been observed. However, such an increase concerns only isolated PVCs, is conditioned by the pattern of preexisting arrhythmias and is independent of plasma aminophylline level. Acute intravenous administration of salbutamol during infusion of aminophylline is not associated with a higher incidence of major arrhythmias. So we conclude that such a pharmacological combination does not represent an additional risk of serious cardiac rhythm disturbances in a selected population of COLD patients without further known arrhythmogenic risk factors. Moreover, plasma aminophylline levels are not predictive of a possible higher incidence of ventricular arrhythmias.

[Plasma exchange treatment in a patient with severe Schoenlein-Henoch purpura]. / Il trattamento mediante plasma-exchange di una paziente con grave porpora di Schoenlein-Henoch.

A patient with severe Henoch-Schoenlein purpura was successfully treated by combined plasmapheresis and cyclophosphamide therapy. PE proved to be effective in the symptomatic treatment of the disease. Its possible role in the prevention and treatment of HS nephritis is suggested.

Plasma exchange in management of a patient with diffuse necrotizing cutaneous vasculitis.

It has been sufficiently established that the so-called small vessel vasculitis results from hypersensitivity reactions to various endogenous or exogenous antigens, and that, in most cases, the pathogenic mechanism is the deposition of immune complexes in the blood vessel wall. Among the therapeutic protocol that have been applied recently, plasma exchange (PE) received little attention, that only a few cases have been treated accordingly until now. Here, we present a patient with diffuse cutaneous necrotizing vasculitis, in whom PE proved to be of irreplaceable benefit in halting the progression of the disease. When PE was discontinued, the disease relapsed in spite of therapy with steroids and heparin. A second series of PE again controlled the disease activity. The authors point out the PE was of unique value pending the effects to treatment with cyclophosphamide, which remains the essential therapeutic agent.