Unusual and unrelated polyclonality in a case of myeloid disease.

A case of myelofibrosis with myeloid metaplasia was found to have five cytogenetically unrelated clones in the marrow, four of these clones being abnormal. We present the hypothesis that the hematologic disease in this patient was caused by a genetic event not discernible microscopically (cytogenetically) and that the distinctive abnormal clones may have been generated at different anatomic sites.

A case of therapy-related extramedullary acute promyelocytic leukemia.

We report a patient with extramedullary acute promyelocytic leukemia (APL) occurring after radiation therapy for carcinoma of the prostate. To the authors' knowledge, this patient represents the first case of cytogenetically and fluorescence in situ hybridization (FISH) confirmed therapy-related extramedullary APL. In contrast to the majority of previously reported t-APL, this case underwent a very unfavorable course.

Lamellar body number density and the prediction of respiratory distress.

The determination of amniotic fluid lamellar body number density (LBND) has recently been shown to correlate well with other established indicators of fetal lung maturity. The authors have compared the LBND with a fetal lung phospholipid profile in predicting the clinical outcome in 52 well-documented cases. If a cutoff of 30,000/microL was used to indicate fetal lung maturity, there were no false-negative results for the LBND whereas there was one for the fetal lung profile. On the other hand, this cutoff resulted in 22 false-positive results for the LBND, whereas there were only 7 false-positive results by the fetal lung profile. The number of false-positive results by the LBND can be decreased by using a separate cutoff of less than 10,000/microL to indicate high risk for development of respiratory distress, while leaving the cutoff for predicting mature lung at 30,000/microL. This resulted in only four false-positive results for the LBND; each of these were from the same patients who also had false-positive results by the fetal lung profile. Care must be taken to ensure that the particle counter used is properly calibrated and that the appropriate cutoffs for both lung maturity and immaturity are used.

Umbilical artery catheterization complicated by multiple mycotic aortic aneurysms.

A premature infant had three pseudoaneurysms of the thoracic and abdominal aorta secondary to umbilical artery catheterization and sepsis. The infant had septicemia as the direct result of bacterial contamination of an umbilical artery catheter with Staphylococcus aureus. The thoracic pseudoaneurysm caused massive hemothorax and the infant's death. The upper abdominal aortic aneurysm developed at the level of the renal arteries and caused decreased left renal blood flow and renal hypoplasia. The lower abdominal aneurysm involved the right iliac artery and was complicated by mural thrombosis and ischemia of the right leg. To our knowledge, this is the first published case of multiple mycotic aortic aneurysms after umbilical artery catheterization.

Immunoradiometric serum ferritin concentration compared with stainable bone-marrow iron as indices to iron stores.

Immunoradiometric analysis has made it possible to measure ferritin reliably in serum. The determination is a sensitive means of assessing body iron because concentrations of ferritin closely parallel the body's reticuloendothelial iron stores. The information provided is similar to that obtained from bone-marrow aspirates or biopsies stained for iron with Prussian Blue. Comparative studies indicate good correlation between iron content in the marrow and serum ferritin, except possibly in patients with leukemia and metastatic tumors to the bone marrow. The clinical value of the assay in relation to other indicators of iron status (i.e., hemoglobin, erythrocyte indices, serum iron and iron-binding capacity, and erythrocyte protoporphyrin) is in its specificity and sensitivity for assaying physiological iron stores.

Anti-A1 in the plasma of platelet concentrates causing a hemolytic reaction.

A patient with acute leukemia who typed as AintB received 10 packs of platelets of group 0. Subsequent transfusion of A1B blood resulted in a hemolytic transfusion reaction. Anti-A1 was detected in the serum and on the red blood cells of a post-transfusion sample. This anti-A1 reacted with the transfused A1B red blood cells and other A1 cells, but not with the patient's pretransfusion red blood cells. The plasma of the transfused platelet concentrates had a high titer of immune anti-A.

The ultrastructure of striated muscle.

Striated muscle is a tissue in which the major cytoplasmic components are spatially arranged to produce directional motion. This orientation is seen at all levels of structure, beginning with the molecular placement of characteristic proteins into 2 dissimilar types of filaments, and proceeding ultimately to the alignment of muscle fibers in the heart or an anatomically defined skeletal muscle. Generation of contractile force is accomplished by the enzymatic interaction of the 2 dissimilar protein filaments, which results ultimately in the utilization of energy (in the form of adenosine triphosphate) and the production of directional motion.