Aleukemic Leukemia Cutis Manifesting with Disseminated Nodular Eruptions and a Plaque Preceding Acute Monocytic Leukemia: A Case Report

Aleukemic leukemia cutis (ALC), a discrete tumor of leukemic cells involving the skin, may be the first manifestation of acute myeloid leukemia, preceding the onset in marrow and blood by months and years. ALC is often difficult to diagnose and is associated with a dismal prognosis. A 63-year-old male presented with nodular swellings on the face, a plaque extending over the right shoulder and multiple enlarged cervical lymph nodes. The skin biopsy of the plaque lesion showed a diffuse neoplastic infiltration extending from the dermis to subcutaneous tissue with diffuse positivity for myeloperoxidase and focal positivity for CD34 on immunohistochemical staining. The diagnosis was leukemia cutis. One month later, acute monocytic leukemia (FAB AML-M5b) was diagnosed. The patient died on the seventh month of diagnosis

False positivity of magnetic resonance imaging under the effect of granulocyte-colony stimulating factor in a child with leukemia

Granulocyte-colony stimulating factor (G-CSF) increases the proliferation and maturation of committed polymorphonuclear leukocyte precursors, as well as the function of mature polymorphonuclear leukocytes. It has previously been shown in pediatric patients that G-CSF induces reconversion of fatty bone marrow to hematopoietic bone marrow in the pelvis and lower extremities that is detectable by magnetic resonance imaging (MRI). Here, we report a 13-year-old Burkitt leukemia patient with bone pain while he was in remission. He was on G-CSF after cessation of high-dose and low-dose cytarabine chemotherapy. He was suspected to have a leukemia relapse. Pelvic MRI was consistent with leukemic infiltration. However, the pathology of bone marrow biopsy resulted in normal findings. Thus it was suggested that concurrent administration of G-CSF could be the causative agent for both bone pain and false-positive MRI findings. The control MRI after interruption of G-CSF revealed normal findings. In conclusion, radiologists should be informed about the type of therapy, including G-CSF administration, in order to overcome misinterpretation of bone marrow MRI

Short Communication Nutritional Status and Immune Functions in Maintenance Hemodialysis Patients

Epidemiological studies suggest various kinds of immune dysregulation in hemodialysis (HD) patients. The aim of this study was to investigate the relationship between immune functions and nutritional status of HD patients. We studied 54 patients with ESRD on chronic HD, included 34 females and 20 males with mean age 46.6 ± 16.3 (18-77) years. We measured the height and dry weight of all patients. The BMI was calculated by dividing weight (kg) by height squared (m 2 ). In all patients serum urea, creatinine, albumin, iron, cholesterol, triglyceride, CRP, IgG, IgM, IgA, CD4, CD8, CD19, CD16-56 lymphocytes were measured. Kt/V values were calculated according to DOQI guideline. In this study, a positive correlation between albumin, cholesterol, and triglyceride levels as nutritional parameters and immune functions in terms of total and subtype lymphocyte counts was observed. Further prospective studies are needed to determine the clinical importance of this finding and the appropriate means of measurement and effects of nutrition on immune function in hemodialysis patients

Recognizing true H5N1 infections in humans during confirmed outbreaks.

INTRODUCTION: The goal of this study was to evaluate whether any characteristics that are evident at presentation for urgent medical attention could be used to differentiate cases of H5N1 in the absence of viral testing. METHODOLOGY: Information about exposure to poultry, clinical signs and symptoms, treatments, and outcomes was abstracted from existing data in the global avian influenza registry (www.avianfluregistry.org) using standardized data collection tools for documented and possible cases of H5N1 infection who presented for medical attention between 2005-2011 during known H5N1 outbreaks in Azerbaijan, Indonesia, Pakistan and Turkey. RESULTS: Demography, exposure to poultry, and presenting symptoms were compared, with only the common symptoms of fever and headache presenting significantly more frequently in confirmed H5N1 cases than in possible cases. Reported exposure to  infected humans was also more common in confirmed cases. In contrast, unexplained respiratory illness, sore throat, excess sputum production, and rhinorrhea were more frequent in possible cases. Overall, oseltamivir treatment showed a survival benefit, with the greatest benefit shown in H5N1 cases who were treated within two days of symptom onset (51% reduction in case fatality). CONCLUSION: Since prompt treatment with antivirals conferred a strong survival benefit for H5N1 cases, presumptive antiviral treatment should be considered for all possible cases presenting during an outbreak of H5N1 as a potentially life-saving measure

Mucosa-associated lymphoid tissue lymphoma of the duodenum together with multiple intra-abdominal thromboses and hepatitis C virus infection: a case report

Mucosa associated lymphoid tissue MALT lymphoma is a low grade malignancy that arises most commonly from the gastric mucosa. Small intestinal involvement is very rare. The causative relationship between Helicobacter pylori and the gastric MALT lymphoma is a well known issue, but recently there are several data suggesting the role of hepatitis C virus (HCV) infection in the pathogenesis of lymphoma including MALT lymphoma. Herein we present a rare case of duodenal MALT lymphoma with multiple intra-abdominal thromboses together with HCV infection that was confirmed by real-time polymerase chain reaction detecting HCV-RNA within the peripheral blood mononuclear cells

Magnetic resonance imaging based kidney volume assessment for risk stratification in pediatric autosomal dominant polycystic kidney disease

IntroductionIn the pediatric context, most children with autosomal dominant polycystic kidney disease (ADPKD) maintain a normal glomerular filtration rate (GFR) despite underlying structural kidney damage, highlighting the critical need for early intervention and predictive markers. Due to the inverse relationship between kidney volume and kidney function, risk assessments have been presented on the basis of kidney volume. The aim of this study was to use magnetic resonance imaging (MRI)-based kidney volume assessment for risk stratification in pediatric ADPKD and to investigate clinical and genetic differences among risk groups.MethodsThis multicenter, cross-sectional, and case-control study included 75 genetically confirmed pediatric ADPKD patients (5–18 years) and 27 controls. Kidney function was assessed by eGFR calculated from serum creatinine and cystatin C using the CKiD-U25 equation. Blood pressure was assessed by both office and 24-hour ambulatory measurements. Kidney volume was calculated from MRI using the stereological method. Total kidney volume was adjusted for the height (htTKV). Patients were stratified from A to E classes according to the Leuven Imaging Classification (LIC) using MRI-derived htTKV.ResultsMedian (Q1-Q3) age of the patients was 6.0 (2.0–10.0) years, 56% were male. There were no differences in sex, age, height-SDS, or GFR between the patient and control groups. Of the patients, 89% had PKD1 and 11% had PKD2 mutations. Non-missense mutations were 73% in PKD1 and 75% in PKD2. Twenty patients (27%) had hypertension based on ABPM. Median htTKV of the patients was significantly higher than controls (141 vs. 117 ml/m, p = 0.0003). LIC stratification revealed Classes A (38.7%), B (28%), C (24%), and D + E (9.3%). All children in class D + E and 94% in class C had PKD1 variants. Class D + E patients had significantly higher blood pressure values and hypertension compared to other classes (p > 0.05 for all).DiscussionThis study distinguishes itself by using MRI-based measurements of kidney volume to stratify pediatric ADPKD patients into specific risk groups. It is important to note that PKD1 mutation and elevated blood pressure were higher in the high-risk groups stratified by age and kidney volume. Our results need to be confirmed in further studies

Initial Oxidation Kinetics of Al(111): A Monte Carlo Study

Almost all metals around us have a thin oxide layer on top of the bulk metal underneath. Often this oxide film protects the metal against further oxidation, or corrosion. Examples are the oxide film that makes stainless steel "stain-less" or the ones on titanium and aluminium alloys, which are very corrosion resistant. Thin metal oxide films have also many other technological applications, based on their mechanical, optical, electrical or biocompatible properties. In spite of their technological importance there are still many unanswered questions regarding the details of how the oxide films form and grow on metal (and semiconductor) surfaces. This concerns both the very initial nucleation of the oxide film and its subsequent growth. In this thesis the former regime is addressed. The situation of interest here is when a fresh metal, i.e. a clean metal surface with only metal atoms and no prior oxide or adsorbates on the surface, is exposed to oxygen molecules. A common sequence of events for many metals is that oxygen molecules initially adsorb and dissociate on the surface, and form a two dimensional layer of chemisorbed oxygen atoms. As the surface coverage increases, nucleation of oxide eventually occurs. It is this process that has been studied in this thesis by means of Monte Carlo (MC) simulations. The specific model system for this work is the Al(111) surface exposed to O2 molecules. This system constitutes an extremely interesting model system both because of its technical importance and because it exhibits a complex and rich behavior in the initial chemisorption and oxide nucleation regime. Furthermore there is a richness of experimental data available, both regarding the structure, i.e. the atomic arrangements of oxygen atoms on the surface, and about the kinetics of oxygen uptake and oxide nucleation. Finally there are a number of open, challenging questions about the whole process. The adsorption dynamics is peculiar for the O2/Al(111) system; upon dissociation the oxygen atoms can either take nearest neighbor sites on the surface ("normal dissociation"), or undergo so called "abstraction", meaning that one of the atoms is ejected into vacuum or to a distant (of order 10 nm) position on the surface. The branching ratio between these two channels depend strongly on the incident energy. This complex behavior opens up for very special kinetics and affects the distribution of oxygen atoms on the surface and the relative abundance of chemisorbed monomers, dimers, trimers etc. It also affects the oxide nucleation. The latter occurs when the chemisorbed O coverage exceeds 0.15 monolayers. In the present work a Monte Carlo simulation platform, based on the lattice-gas approach, has been established and applied to simulate the kinetics of the O2/Al(111) system. The adsorption kinetics in the low coverage regime and the initial oxide nucleation kinetics have been simulated, incorporating the available experimental and first principle calculations results. Elementary processes that are not yet known in sufficient detail, but suggested to play a role, have been explored in the simulations to see if they can explain the experimental data, and / or suggest new experiments. In the early part of the work the experimental adsorption kinetics and resulting distribution of adatoms in the thermal regime could be described quite well. In the later part incorporation of the results for higher incident energies were treated. In the last paper incorporation of short and long range O-O adatom interactions made it possible to reproduce the experimental data, including both the initial chemisorption phase and the transition to oxide formation on the surface

Initial Oxidation Kinetics of Al(111): A Monte Carlo Study

Almost all metals around us have a thin oxide layer on top of the bulk metal underneath. Often this oxide film protects the metal against further oxidation, or corrosion. Examples are the oxide film that makes stainless steel "stain-less" or the ones on titanium and aluminium alloys, which are very corrosion resistant. Thin metal oxide films have also many other technological applications, based on their mechanical, optical, electrical or biocompatible properties. In spite of their technological importance there are still many unanswered questions regarding the details of how the oxide films form and grow on metal (and semiconductor) surfaces. This concerns both the very initial nucleation of the oxide film and its subsequent growth. In this thesis the former regime is addressed. The situation of interest here is when a fresh metal, i.e. a clean metal surface with only metal atoms and no prior oxide or adsorbates on the surface, is exposed to oxygen molecules. A common sequence of events for many metals is that oxygen molecules initially adsorb and dissociate on the surface, and form a two dimensional layer of chemisorbed oxygen atoms. As the surface coverage increases, nucleation of oxide eventually occurs. It is this process that has been studied in this thesis by means of Monte Carlo (MC) simulations. The specific model system for this work is the Al(111) surface exposed to O2 molecules. This system constitutes an extremely interesting model system both because of its technical importance and because it exhibits a complex and rich behavior in the initial chemisorption and oxide nucleation regime. Furthermore there is a richness of experimental data available, both regarding the structure, i.e. the atomic arrangements of oxygen atoms on the surface, and about the kinetics of oxygen uptake and oxide nucleation. Finally there are a number of open, challenging questions about the whole process. The adsorption dynamics is peculiar for the O2/Al(111) system; upon dissociation the oxygen atoms can either take nearest neighbor sites on the surface ("normal dissociation"), or undergo so called "abstraction", meaning that one of the atoms is ejected into vacuum or to a distant (of order 10 nm) position on the surface. The branching ratio between these two channels depend strongly on the incident energy. This complex behavior opens up for very special kinetics and affects the distribution of oxygen atoms on the surface and the relative abundance of chemisorbed monomers, dimers, trimers etc. It also affects the oxide nucleation. The latter occurs when the chemisorbed O coverage exceeds 0.15 monolayers. In the present work a Monte Carlo simulation platform, based on the lattice-gas approach, has been established and applied to simulate the kinetics of the O2/Al(111) system. The adsorption kinetics in the low coverage regime and the initial oxide nucleation kinetics have been simulated, incorporating the available experimental and first principle calculations results. Elementary processes that are not yet known in sufficient detail, but suggested to play a role, have been explored in the simulations to see if they can explain the experimental data, and / or suggest new experiments. In the early part of the work the experimental adsorption kinetics and resulting distribution of adatoms in the thermal regime could be described quite well. In the later part incorporation of the results for higher incident energies were treated. In the last paper incorporation of short and long range O-O adatom interactions made it possible to reproduce the experimental data, including both the initial chemisorption phase and the transition to oxide formation on the surface