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  • 1
    Electronic Resource
    Electronic Resource
    Pseudoreticulocytosis in a patient with myelodysplasia (1993)
    Springer
    Annals of hematology 67 (1993), S. 127-128 
    Details
    ISSN: 1432-0584
    Keywords: Myelodysplastic syndrome ; Reticulocytes ; Erythrocyte abnormalities
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A patient with a myelodysplastic syndrome (MDS) and reticulocytosis of 〉50% in the absence of a correspondingly increased erythrocyte turnover is reported. Evaluation of the kinetics of erythrocyte turnover revealed a decreased erythrocyte life span of 44 days. From these data a prolongation of the reticulocyte maturation time to 〉20 days can be concluded. The patient's erythrocytes lacked the increase of mean corpuscular volume and a significant increase of erythrocyte enzymes that would be expected in marked reticulocytosis. This finding suggests that the reticulocytes represented not newly formed red blood cells, but “pseudoreticulocytes”, i.e., mature erythrocytes that retained their substantia reticulofilamentosa.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01701735
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  • 2
    Electronic Resource
    Electronic Resource
    Thrombotic thrombocytopenic purpura in early pregnancy with maternal and fetal survival (1992)
    Springer
    Annals of hematology 64 (1992), S. 245-248 
    Details
    ISSN: 1432-0584
    Keywords: Thrombotic thrombocytopenic purpura ; Pregnancy ; Plasma exchange ; Plasma infusions ; Antiplatelet agents
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Thrombotic thrombocytopenic purpura (TTP) is a hematologic disorder which is clinically characterized by thrombocytopenia, microangiopathic hemolytic anemia, fever, neurologic symptoms, and cardiac and renal involvement. The pathogenic mechanisms of this disease are poorly understood. It is well known that TTP is associated with pregnancy and that prognosis for the mother and child is poor. We present the first case of a severe TTP diagnosed in the first trimester of pregnancy (13th week of gestation) with maternal survival and birth of a healthy child which required continuous and intensive treatment with plasmatherapy until delivery. During a period of 24 weeks several attempts to discontinue plasma therapy failed because of continuous active disease, and it became evident that plasma infusions were not as effective as plasma exchanges. The fact that the patient entered into remission soon after delivery of a healthy child by cesarean section in the 37th gestational week shows that in this case pregnancy activated an unknown factor which does not cross the placenta and which can be removed by plasmapheresis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01738304
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  • 3
    Electronic Resource
    Electronic Resource
    Corynebacterium jeikeium bacteremia at a tertiary care center (1991)
    Springer
    Infection 19 (1991), S. 201-204 
    Details
    ISSN: 1439-0973
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung In einer Universitätsklinik wurde während eines Zeitraumes von sechs Jahren bei 23 PatientenCorynebacterium jeikeium aus Blutkulturen isoliert.C. jeikeium-Bakteriämien traten weder zeitlich noch örtlich gehäuft auf. Die retrospektive Analyse der Patientendaten zeigte, daß in den meisten Fällen eine maligne hämatologische Grunderkrankung mit Neutropenie vorlag, ein zentral-venöser Katheter implantiert und eine antibiotische Therapie vorausgegangen war. Die Patientenpopulation mit nur einer positiven Blutkultur unterschied sich in wichtigen Aspekten von derjenigen mit mehreren positiven Blutkulturen. So waren Patienten mit nur einer positiven Blutkultur seltener an akuter Leukämie erkrankt, hatten signifikant höhere neutrophile Granulozytenkonzentrationen im peripheren Blut und waren zuvor über einen kürzeren Zeitraum antibiotisch behandelt worden. Weiterhin fanden sich in dieser Patientengruppe in allen Fällen andere mögliche Ursachen der Fieberepisoden. Auch die Mortalität war deutlich geringer. Trotz des zunehmend häufigeren Nachweises vonCorynebacterium jeikeium in Blutkulturen bleiben schwere Infektionen durch diesen Erreger weiterhin meist auf die Patientenpopulation mit hämatologischer Grunderkrankung und Neutropenie beschränkt.
    Notes: Summary During a six-year period 23 patients with isolation ofCorynebacterium jeikeium (formerly known asCorynebacterium group JK) from one or more blood cultures at a university hospital were identified. Cases occurred sporadically without time- or ward-related clustering. Review of the cases showed that most infections were nosocomial, that most of the patients had underlying malignant disease, had a chronic intravascular catheter implanted, had been pretreated with antibiotics, and were neutropenic at the time the blood cultures were drawn. Patients with only one versus those with more than one positive blood culture differed in some important aspects. Patients with only one positive blood culture were less likely to have acute leukemia, had significantly higher neutrophil counts and a shorter duration of preceding antibiotic treatment, and all had other probable causes of infection and fever. The mortality also appeared to be lower in these patients. Despite the possibility of increasing frequency of blood cultures positive forC. jeikeium, severe infections due to this organism continue to be largely confined to neutropenic patients with hematologic malignancy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01644945
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  • 4
    Electronic Resource
    Electronic Resource
    Streptococcal bacteremia in adult patients with leukemia undergoing aggressive chemotherapy. A review of 55 cases (1990)
    Springer
    Infection 18 (1990), S. 138-145 
    Details
    ISSN: 1439-0973
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die vorliegende Arbeit analysiert 55 Fälle von Streptokokken-Bakteriämie bei erwachsenen Patienten nach aggressiver antileukämischer Chemotherapie. Vergrünende Streptokokken waren die häufigsten Erreger (45 Isolate). Beta-hämolysierende Streptokokken (vier Isolate), Pneumokokken (drei Isolate) und Enterokokken (drei Isolate) waren dagegen eher selten. Klinisch waren die Infektionen gekennzeichnet durch Fieber, Beteiligung des oberen und unteren Respirationstrakts, Weichteilinfektion, durch Atemnotsyndrom und septischen Schock. 40 Patienten, bei denen ausschließlich Streptokokken in der Blutkultur nachgewiesen wurden, wurden verglichen mit 36 Patienten (ausgewählt nach denselben Kriterien) mit gramnegativer bakteriämischer Infektion. Die Gegenüberstellung ergab, daß Patienten mit Streptokokken-Bakteriämien häufiger hochdosiertes Cytosin-Arabinosid erhalten hatten (17 versus fünf Tage), eine längere Fieberdauer hatten (11 versus sieben Tage, P〈0.01), etwas länger antibakterielle Therapie benötigten (15 versus zwölf Tage, P=0.07, nicht signifikant) und häufiger mit Fluorochinolonen zur Infektprophylaxe behandelt waren (30 versus acht). Beide Gruppen unterschieden sich nicht hinsichtlich Alter, Grunderkrankung, Dauer der Granulozytopenie und Häufigkeit von Superinfektionen. Die Letalität betrug 18% bei Streptokokken-Bakteriämie und 17% bei Gram-negativer Bakteriämie. Die Untersuchung zeigt, daß Streptokokken, besonders vergrünende Streptokokken, ungewöhnlich häufig unerwartet schwere Infektionen bei Patienten nach antileukämischer Chemotherapie verursachen können.
    Notes: Summary We reviewed 55 cases of streptococcal bacteremia in adult patients who received cytotoxic chemotherapy for treatment of acute leukemia. Viridans group streptococci were the most frequent species isolated (45 isolates). Hemolytic streptococci (four isolates), pneumococci (three isolates), and enterococci (three isolates) were infrequent. Clinical features of streptococcal bacteremia included fever, upper and lower respiratory infection, respiratory distress syndrome, soft tissue infection, and septic shock. Forty patients who had only streptococci, but no other organisms isolated from their blood, were compared with 36 cases of gram-negative bacillary bacteremia that occurred during the same study period within the same population at risk. The comparison showed that patients with streptococcal bacteremia had more often received high dose cytosine arabinoside as part of their chemotherapy (17 vs. five), had a longer mean duration of fever (11 vs. seven days, p〈0.01) needed slightly more days of antibacterial therapy (15 vs. 12 days, p=0.07, not significant), and were more likely to have been treated with newer quinolones for infection prevention (30 vs. eight). No differences between both groups were found for age, underlying disease, remission status, duration of severe granulocytopenia, and number of superinfections. The overall mortality was 18% in streptococcal bacteremia and 17% in gram-negative bacillary bacteremia. Streptococci, especially viridans group streptococci, should now be regarded as frequent causes of serious life-threatening infections following aggressive chemotherapy in patients with hematologic malignancies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01642101
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  • 5
    Electronic Resource
    Electronic Resource
    Ofloxacin versus trimethoprim-sulfamethoxazole for prevention of infection in patients with acute leukemia and granulocytopenia (1991)
    Springer
    Infection 19 (1991), S. 73-80 
    Details
    ISSN: 1439-0973
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung In einer prospektiven, randomisierten Studie wurden die Wirksamkeit und Verträglichkeit von Ofloxacin (dreimal 200 mg täglich) im Vergleich mit Trimethoprim-Sulfamethoxazol (dreimal 960 mg täglich) als antibakterielle Prophylaxe bei Patienten mit akuter Leukämie geprüft. Beurteilbar waren 128 Patienten, die eine aggressive cytostatische Chemotherapie erhielten, mit einer medianen Granulozytopeniedauer von 30 Tagen. In der Ofloxacin-Gruppe wurde eine Kolonisierung mitEnterobacteriaceae (13% gegenüber 90%, p〈0.001) undPseudomonas aeruginosa (3% gegenüber 14%, p=0.025) wesentlich seltener beobachtet als in der Trimethoprim-Sulfamethoxazol-Gruppe. Patienten, die Ofloxacin erhielten, entwickelten auch weniger gram-negative Infektionen (4% gegenüber 26%, p=0.002), während die Inzidenz von gram-positiven bakteriellen (19% gegenüber 22%) und von Pilzinfektionen (7% gegenüber 14%) in beiden Gruppen vergleichbar war. Ofloxacin war besser verträglich und verkürzte die Feiberdauer (p=0.02) sowie die Dauer der parenteralen antimikrobiellen Behandlung von vermuteten oder dokumentierten erworbenen Infektionen (p=0.01). In der Prophylaxe gramnegativer Infektionen bei Patienten mit akuter Leukämie erscheint Ofloxacin daher eine wirksamere und besser verträgliche Alternative zu Trimethoprim-Sulfamethoxazol zu sein. Möglichkeiten einer gezielten Prophylaxe gegen grampositive Infektionen sollten jedoch weiterhin überprüft werden.
    Notes: Summary In a prospective randomized study we evaluated the efficacy and safety of oral ofloxacin (dosage: 200 mg three times daily) versus trimethoprim-sulfamethoxazole (dosage: 960 mg three times daily) as antibacterial prophylaxis in 128 patients with acute leukemia who received aggressive cytotoxic chemotherapy and were granulocytopenic for a median duration of 30 days. Fewer patients receiving ofloxacin were colonized byEnterobacteriaceae (13% versus 90%, p〈0.001) andPseudomonas aeruginosa (3% versus 14%, p=0.025), and developed gram-negative bacterial infection (4% versus 26%, p=0.002), whereas the incidence of gram-positive bacterial (19% versus 22%) and fungal (7% versus 14%) infections was similar in both groups. Ofloxacin was significantly better tolerated than trimethoprim-sulfamethoxazole, and shortened the duration of fever (p=0.02) and of parenteral antimicrobial therapy for presumed or documented acquired infection (p=0.01). Ofloxacin appears to be a safe, effective, well-tolerated alternative to trimethoprim-sulfamethoxazole for preventing gram-negative infection in acute leukemia, but more effective prophylaxis of gram-positive infections is still needed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01645571
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