[C-reactive protein and relative lymphocytopenia: early markers of acute myocardial infarction?]. / C-reaktives Protein und relative Lymphozytopenie: Frühmarker des akuten Myokardinfarkts?

OBJECTIVE: Recent data suggest that relative lymphocytopenia and elevated C-reactive protein (CRP) are early markers of myocardial infarction. We tested these two parameters to predict myocardial infarction before elevation of creatine kinase. METHODS: Over a two-year period, 260 patients presented at the emergency room of Männedorf Hospital with suspicion of unstable angina or myocardial infarction. 197 patients were excluded because of intercurrent conditions associated with an acute-phase response or changes in leukocyte counts, as well as patients with established myocardial infarction (creatine kinase elevation at entry). The remaining 63 patients were reviewed for relative lymphocytopenia (< 20.3%) and C-reactive protein levels > 5 mg/l at admission. RESULTS: Elevated levels of C-reactive protein were found in 8 of 20 patients (40%) with unstable angina and in 29 of 43 patients (67%) with myocardial infarction. A value for C-reactive protein > 5 mg/l on admission had a sensitivity of 67% and a predictive value of 78% for subsequent myocardial infarction. Relative lymphocytopenia was found in 2 patients (10%) with unstable angina and in 19 patients (44%) with myocardial infarction. The positive predictive value of both markers diagnosing myocardial infarction was 93% compared to 78% of elevated CRP or 90% of relative lymphocytopenia. In contrast, the sensitivity of both markers combined was 33%. CONCLUSIONS: At present, elevation of C-reactive protein and relative lymphocytopenia allow early diagnosis of myocardial infarction. However, the markers' sensitivity is relatively low.

[Mixed cryoglobulinemia and vasculitic neuromyopathy]. / Gemischte Kryoglobulinämie und vaskulitische Neuromyopathie.

Over a period of 25 years, a 67-year-old man again and again developed purpura over the lower legs. When hospitalized because of splenomegaly with thrombocytopenia the diagnosis of idiopathic thrombocytopenic purpura was made. Four years later, after an infection of the upper respiratory tract, purpura again developed, together with a symmetrical sensory-motor polyneuropathy with flaccid paraparesis. Biopsy of the N. suralis revealed a florid leukocytoclastic vasculitis. Morphologically there was severe nerve damage with Wallerian degeneration and subtotal nerve fibre loss. Immunological tests demonstrated essential mixed cryoglobulinaemia of IgG/IgM type. Cryoprecipitates must be considered as the cause of the vasculitis, which in turn produced the nerve lesions and purpura. This case underlines the importance of biopsy diagnosis of peripheral nerve and skeletal muscle, because it may demonstrate a treatable cause of a severe acute neuromyopathy.

[Hodgkin disease, stage I through III A: treatment results at the Zurich University Hospital from 1974 to 1985 and current procedures]. / Morbus Hodgkin, Stadien I bis III A: Behandlungsergebnisse am Universitätsspital Zürich von 1974 bis 1985 und aktuelles Prozedere.

UNLABELLED: 1974 to 1985, 148 patients with M. Hodgkin I to III A have been treated at the University Hospital Zurich with radiotherapy or radiotherapy and chemotherapy. Ten year survival rates (recurrence free) are: all patients 88% (67%); all with primary radiotherapy 88% (58%); PS I A/II A and radiotherapy 94% (63%); PS III A and primary radiotherapy 78% (56%); patients with recurrence after primary radiotherapy 69% (73%). COMPLICATIONS: four cases of acute leukaemia, one case of pancytopenia and sepsis and one case with a myeloproliferative syndrome. Cumulative frequency of leukaemia after ten years is about 7%. Three patients suffered from secondary solid neoplasia. 94% of all living patients are free of symptoms and are working 100%. Based on Ann-Arbor stage, number and volume of involved regions, age, histology, general symptoms and the sedimentation rate, patients with M. Hodgkin CS I to III A can be subdivided in three groups with the following risks of recurrence after primary irradiation without staging laparotomy and splenectomy: a favourable group with a recurrence risk of about 20%. For these patients, primary radiotherapy after clinical staging is an acceptable therapy. In a second group with a high recurrence risk of greater than 50% after irradiation, primary chemotherapy is indicated, usually with additional irradiation of the main tumour manifestations. In a third group with a medium recurrence risk, laparotomy may be further indicated.

[Acute osteomyelofibrosis. An overview and 2 personal cases]. / Die akute Osteomyelofibrose. Eine Ubersicht anhand von zwei eigenen Fällen.

Two cases of acute myelofibrosis are described which exemplify diagnostic and therapeutic possibilities in this clinical and morphologic entity. Delimiting criteria against other diseases with bone marrow fibrosis are also presented. This malignant myeloproliferative disorder is characterized by acute onset, minimal or absent splenomegaly, blood cytopenias with a highly variable percentage of blast cells in circulating blood, often unimpressive tear-drop poikilocytosis, intense marrow fibrosis, and a rapid clinical course. In one case, typical proliferation of all three hematopoietic cell lines was lacking and proliferating blast cells could be classified as myeloblasts/promyelocytes histochemically. In the other case, a single course of intensive combination chemotherapy resulted in marked dissolution of the marrow fibrosis and prolonged survival in partial remission.

[Legionnaires' disease in the Lake Zurich area. Report on 6 sporadic cases]. / Die Legionärskrankheit am Zürichsee. Bericht über 6 sporadische Fälle.

Six sporadic cases of Legionnaires' disease seen over 13 months in the region of Lake Zurich (Switzerland) are reported. The disease was severe in all cases; 2 patients died while on artificial respiration; 5 patients were heavy smokers; 3 had probably acquired the infection in France. These 6 patients showed the following typical symptoms and signs: fever above 39 degrees C (6 patients), nonproductive cough (4), gastrointestinal symptoms (4), encephalopathy (4), renal insufficiency (5), hepatic involvement (4), bilateral pneumonia (4), and pO2 below 60 mm Hg (4). The disease was diagnosed serologically in all cases and by staining and culturing Legionella pneumophila from lung tissue in one case. The authors propose to treat unusual cases of pneumonia with erythromycin from the outset.