Detection of malignant cells in serous body fluids by counting high-fluorescent cells on the Sysmex XN-2000 hematology analyzer.

INTRODUCTION: The body fluid mode of the Sysmex XN-2000 hematology analyzer differentiates cells into mononuclear and polymorphonuclear white blood cells (WBC) and high-fluorescent cells (HFC). The aim of this study was to evaluate the performance of the HFC count for detecting malignant cells in serous body fluids. METHODS: Two-hundred and thirty serous fluids were analyzed on the Sysmex XN body fluid mode. HFC were measured as relative count (HFC/100 WBC) and absolute count (HFC/µL). All samples were microscopically screened on cytospin slides for the presence of malignant cells. RESULTS: Malignant cells were found by microscopic examination in 49 of 230 samples (21.3%). Malignant samples contained significantly higher percentages (10.2 vs. 2.6/100 WBC) and absolute numbers (65 vs. 10/µL) of HFC than nonmalignant samples (P < 0.001). Areas under the ROC curve for relative and absolute HFC count were 0.69 and 0.77, respectively. A cutoff level of ≥17 HFC/µL showed the best performance to predict malignancy, with 88% sensitivity and 61% specificity. CONCLUSION: As serous body fluids will be more analyzed on automated analyzers in the future, HFC count can be a useful tool to select samples for microscopic review. Microscopic evaluation should be performed if HFC values are above a certain threshold (e.g. ≥17 HFC/µL) or in case of clinical suspicion of malignancy.

Safety of alternative medicines reconsidered: lead-induced anaemia caused by an indian ayurvedic formulation.

We report two cases of Belgian women diagnose with a lead poisoning. Both patients presented with abdominal pain and a normochromic normocytic anaemia. The diagnosis was based on the clinical symptoms, the anaemia, the basophilic stippling of erythrocytes and the elevated blood lead level Upon further questioning, both patients reported the use of Ayurvedic medications. Toxicological analysis of the different pills revealed that, in both, the same orange-red pills contained a remarkably high amount of lead. Cases of lead poisoning associated with the use ofAyurvedic formulations are emerging around the world. However, to our knowledge, these are the first reported cases in Belgium.

Coexistence of light chain disease and chronic lymphocytic leukaemia, a complex karyotype with a rapid fatal outcome.

We report on a 48-year-old man with concomitantly diagnosed kappa expressing chronic lymphocytic leukaemia (CLL) and lambda light chain disease with highly complex chromosomal aberrations. The clinical course of the disease was very aggressive with survival of only 1 month. We demonstrate the distinct clonal origin by cytogenetic data and immunoglobulin rearrangement studies. To our knowledge this is the first report of a light chain disease associated with CLL.

Functional foods in pediatrics.

The philosophy that food can be health promoting beyond its nutritional value is gaining acceptance. Known disease preventive aspects of nutrition have led to a new science, the 'functional food science'. Functional foods, first introduced in Japan, have no universally accepted definition but can be described as foods or food ingredients that may provide health benefits and prevent diseases. Currently, there is a growing interest in these products. However, not all regulatory issues have been settled yet. Five categories of foods can be classified as functional foods: dietary fibers, vitamins and minerals, bioactive substances, fatty acids and pro-, pre- and symbiotics. The latter are currently the main focus of research. Functional foods can be applied in pediatrics: during pregnancy, nutrition is 'functional' since it has prenatal influences on the intra-uterine development of the baby, after birth, 'functional' human milk supports adequate growth of infants and pro- and prebiotics can modulate the flora composition and as such confer certain health advantages. Functional foods have also been studied in pediatric diseases. The severity of necrotising enterocolitis (NEC), diarrhea, irritable bowel syndrome, intestinal allergy and lactose intolerance may be reduced by using functional foods. Functional foods have proven to be valuable contributors to the improvement of health and the prevention of diseases in pediatric populations.

13C mixed triglyceride breath test: a noninvasive method to assess lipase activity in children.

BACKGROUND: Results from the 13C mixed triglyceride (MTG) breath test correlate with duodenal lipase activity in adults. This noninvasive test is a potential screening and diagnostic tool for children with fat malabsorption. The aim of this study was to adapt the methodology of the MTG breath test to study test meals and sampling methods and to define normal values for healthy children of all age groups; premature and full-term infants have similar pancreatic lipase deficiencies. METHODS: After parental consent was obtained, 12 premature infants (< 37 weeks gestation and with body weights > 2 kg), 12 full-term infants (1-6 months old), 20 children (3-10 years old), and 20 teenagers (11-17 years old) were tested. All children were thriving well, had no gastrointestinal or respiratory problems, and had not received any medication that contained natural 13C. For the premature and full-term infants, a formula was prepared that had a low and stable natural 13C content mixed with 100 mg 13C-labeled MTG (1,3-distearyl, 2-[13C-carboxyl] octanoyl glycerol) and 1 g polyethylene-glycol 3350. The best accepted test meal for children over 3 years old was a slice of white bread with 5 g butter and 15 g chocolate paste, mixed with 250 mg 13C-labeled MTG, and a glass of 100 mL whole-fat milk. Children over 3 years old were able to blow through a straw in a vacutainer for collecting the breath samples. In children under 3 years old, expired air was collected by aspirating breath via a nasal prong. Carbon dioxide production was calculated according to weight, age, and sex. RESULTS: For healthy pediatric control participants, the mean values for cumulative excretion of 13CO2 as a percentage of the administered dose after 6 hours were 23.9 +/- 5.2% in premature infants, 31.9 +/- 7.7% in full-term infants, 32.5 +/- 5.3% in children, and 28.0 +/- 5.4% in teenagers. The mean value for healthy adults is 35.6% with a lower reference limit of 22.8%. CONCLUSIONS: Age-specific test meals and breath-sampling techniques for the MTG breath test were defined. The mean values for different age groups may serve as guidelines for normal values in the pediatric population. The cumulative values for expired 13CO2 were above the lower limit for adults, which suggests that preduodenal lipases compensates for pancreatic lipase deficiency in premature and full-term infants.

Lactose-[13C]ureide breath test: a new, noninvasive technique to determine orocecal transit time in children.

BACKGROUND: The lactose-[13C]ureide breath test (LUBT) is a novel, noninvasive test to determine orocecal transit time. Lactose ureide resists the action of brush border enzymes and is metabolized by colonic bacteria. The purpose of the present study was to adapt this breath test for children of various age groups and to determine whether it can be applied in infants, newborns, and preterms to study the development of small intestinal motility. METHODS: In a group of 20 children (3-17 years) in vitro stool analysis and in vivo LUBT results were compared. From each subject a blank stool sample and a sample produced after induction with unlabeled lactose ureide were incubated with 10 mg lactose-[13C]ureide in small, closed bottles. Ten-milliliter CO2 samples were aspirated from the bottles using a needle and a syringe every 30 minutes for 24 hours. All children performed the breath test after induction of 500 mg unlabeled lactose ureide three times the prior day. A liquid test meal (chocolate milk) with 250 mg lactose-[13C]ureide was ingested. Breath samples were collected every 15 minutes for 10 hours. In a second group of 32 children (age range, 0-3 years) consisting of 6 children between 1 and 3 years of age, 6 infants between 6 and 12 months, 13 infants between 0 and 6 months, and 7 preterm infants, only the in vitro stool analysis was performed. Stools were collected for stool incubation, as described. RESULTS: The mean orocecal transit time in the group of 20 children aged 3 to 17 years was 255 minutes (range, 165-390 minutes). Stool incubations demonstrated a clear 13CO2 peak in all infants aged more than 8 months, indicating that their colonic bacterial enzymic activity hydrolyses lactose ureide. However, in all infants aged less than 6 months and in preterm infants, the 13CO2 signal was absent, indicating that those subjects were unable to hydrolyze lactose ureide. CONCLUSION: Infants aged less than 6 months do not host the appropriate bacterial enzymic activity for splitting lactose ureide. The authors conclude that the LUBT can be applied in infants aged more than 8 months, after weaning to solid foods, to determine orocecal transit time.

Gastric emptying in formula-fed and breast-fed infants measured with the 13C-octanoic acid breath test.

BACKGROUND: The 13C-octanoic acid breath test, a noninvasive method for measuring gastric emptying, was used to compare the gastric-emptying rate of formula-fed and breast-fed infants. Octanoic acid, a medium-chain fatty acid marked with the stable isotope 13C is immediately absorbed in the duodenum. Because gastric emptying is the rate-limiting step for the absorption of medium-chain fatty acids, the fraction of 13C expired in the breath indicates the rate of gastric emptying. METHODS: Twenty-nine newborn infants (16 boys, 13 girls) were investigated, with parental consent. The infants had a mean gestational age at birth of 34.5 weeks (range, 27-41 weeks) and a birth weight of 2148 g (range, 960-4100 g). Their mean weight on the day of the test was 2496 g (range, 1998-4140 g), and their mean age was 23 days (range, 7-74 days). Each infant received a test meal after a maximum fasting period of 3 hours. Fourteen infants were fed formula milk (Nutrilon Premium, NV Nutricia, Zoetermeer, The Netherlands) with 13C-octanoic acid and 15 infants received expressed mother's milk mixed with 13C-octanoic acid. After obtaining two basal breath samples and the feeding, breath samples were collected using a nasal prong, every 5 minutes during the first half hour and every 15 minutes during the next 3.5 hours. Analysis of the expired 13C fraction in the breath samples was performed using isotope-ratio mass spectrometry, and the gastric emptying curve and gastric emptying parameters were determined. RESULTS: The mean half-emptying time determined by the 13C-octanoic acid breath test was 65 minutes (range, 27-98 minutes) for the formula fed infants and 47 minutes (range, 16-86 minutes) for the breast-fed infants. The difference between the half-emptying times is significant (t-test, p < 0.05). CONCLUSIONS: The results of the 13C-octanoic acid breath test indicated faster gastric emptying of human milk than formula. Our findings are in accordance with those in earlier studies, using the invasive-dilution technique; noninvasive and detailed ultrasonography, which is not easily used because it is operator dependent and the observation time is short; or cineesophago-gastroscintigraphy, which is less suitable for infants (because of the radiation involved). The 13C-octanoic acid breath test is a safe and noninvasive method for measuring gastric emptying in small infants and allows comparison of various feeding methods.