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Normal coronary vessels and an akinetic anterolateral wall segment were found in a 24-year-old patient on angiography 10 months after a clinically established myocardial infarction. As the patient had been on a high-dosage medication with ergotamine for two years and as all risk factors for coronary sclerosis as well as evidence of other cardiac diseases were lacking, it seems appropriate to assume that myocardial ischaemia had been caused by coronary spasms.

The continuous subcutaneous infusion of opiate, a new approach to the alleviation of severe chronic pain, has been carried out using a pump system normally employed for the infusion of insulin. Relapses of pain can be controlled with bolus doses. This mode of application was compared with conventional therapy in 11 patients. All patients were free of pain during the continuous infusion, but none showed a satisfactory response during conventional treatment. The improved response under continuous opiate infusion was attained with much lower doses and thus with fewer side effects. The procedure is therefore highly effective and well tolerated.

In a Phase II study, 82 patients with Philadelphia chromosome(Ph)-positive chronic myelogenous leukaemia were treated with 3.5 million I.U./d of recombinant interferon alpha-2c (rIFN). 73 patients have so far been evaluated (42 male, 31 female, mean age 50 [12-87] years). At the start of therapy, 10 were in the accelerated phase (group 1) and 63 in the chronic phase, of whom 19 had received previous treatment with cytotoxics (group 2), while the remainder (group 3, n = 44) had received primary treatment with rIFN. There was short-term stabilization in 7 of the 10 group 1 patients, but none had complete haematological or cytogenetic remission. In contrast, the remission rate (complete or partial haematological remission) was 63% in the previously treated (group 2) and 66% in the previously untreated chronic phase patients (group 3). There was a reduction in the proportion of Ph-positive metaphases in 7 group 2 patients (11%) and in 10 group 3 patients (23%). Complete cytogenetic remission has so far been seen in 2 patients. Cytogenetic improvement occurred after 3 months at the earliest, and in some patients only after 12 to 19 months treatment. Differences in response to treatment were related to stage (prognostic staging system of Kantarjian et al.) in group 3 patients: complete or partial haematological remission was seen in 22 out of 25 patients with stage 1 disease, in 4 out of 7 in stage 2, and in only 3 out of 12 in stages 3 and 4.

Bevacizumab (Avastin®) ist ein humanisierter monoklonaler Antikorper, der gegen den vaskularen endothelialen Wachstumsfaktor (VEGF-A) gerichtet ist. Bevacizumab fuhrt in Kombination mit Chemotherapie zu einer Verbesserung des Ansprechens und einer Verlangerung des progressionsfreien und des Gesamtuberlebens bei Patienten mit metastasiertem kolorektalem Karzinom. Gastrointestinale Perforationen sind eine bekannte Komplikation unter antiangiogener Therapie mit Avastin®. Wir berichten von einer Patientin mit einem Karzinom des Colon ascendens, welche nach Hemikolektomie und adjuvanter Chemotherapie bei Progress 8 Monate nach der Operation eine Kombinationstherapie mit Bevacizumab, Irinotecan, 5-Fluorouracil und Leukovorin erhielt. 2 Monate nach Therapieende kam es zu einer ischamischen Anastomosenperforation und eine Resektion wurde durchgefuhrt. Aufgrund einer Anastomoseninsuffizienz 8 Tage spater war eine Revision mit Stomaanlage notwendig. Uberraschend ist, dass eine Perforation – vermutlich ischamischer Genese – im Bereich einer 10 Monate zuvor angelegten und bis dahin suffizienten Anastomose auftrat. Man muss sich uberlegen, ob im Falle einer Darmperforation unter Bevacizumabtherapie eine Stomaanlage einer primaren Wiederherstellung der Darmpassage der Vorzug gegeben werden sollte.

Three-weekly docetaxel is active in patients with advanced esophagogastric cancer but myelosuppression may make this schedule unsuitable for some patient groups such as elderly, pretreated, or poor performance status patients.Eligible patients were chemonaive with Karnofsky indexor =70% and/or had received prior platinum-based chemotherapy. Docetaxel 35 mg/m(2) was administered on days 1, 8, 15, 22, 29, and 36 of a 49-day cycle. The primary endpoint was disease stabilization rate.Of 46 patients (median age, 68.5 years; 47%or =70 years) included, 87% had Karnofsky indexor =70 and 50% had prior treatment. The safety profile was acceptable. Principal grade 3/4 toxicities were leukopenia (9%) and fatigue (14%). Fifteen patients experienced no progression foror =100 days (disease stabilization rate: 36%). Overall response rate was 9%; median overall survival was 7.0 months.Weekly docetaxel was well tolerated and achieved disease stabilization in one-third of difficult-to-treat patients.

Bevacizumab (Avastin) is a monoclonal antibody against vascular endothelial growth factor (VEGF) receptor that has demonstrated increased overall survival when added to standard chemotherapy regimens in patients with metastatic colorectal cancer. Gastrointestinal perforation is a known risk factor of unknown etiology associated with the use of bevacizumab.We report a 61-year-old woman with adenocarcinoma of the colon ascendens who underwent hemicolectomy and adjuvant chemotherapy with oxaliplatin, 5-fluorouracil, and leucovorin. Eight months after the operation, we started therapy with bevacizumab combined with irinotecan, 5-fluorouracil, and leucovorin due to disease progression. Two months after completion of this therapy, ischemic anastomotic bowel perforation occurred and a resection of the anastomosis was performed. Because of anastomotic insufficiency 8 days later, a further revision had to be done and the terminal ileum and the colon were brought out through a stoma.This case is unusual because the time interval between the primary operation and the application of bevacizumab is regarded as safe with regard to the risk of perforation. An ischemic genesis of the perforation was considered on the basis of the histopathological workup. In case of perforations during therapy with bevacizumab, a safe surgical approach should be preferred, i.e., a transient stoma instead of a primary reconstruction of the bowel passage.

Supernumerary kidney is a rare renal anomaly. As a distinct encapsulated parenchymatous mass, this free accessory organ has a separate blood supply and excretory duct system. We report on a patient who presented with an acute episode of abdominopelvic pain, secondary to hydronephrosis of a third kidney, situated in the pelvis behind the bladder. Modern diagnostic methods assisted in the conservative management of this well functioning third kidney.

Supernumerary kidney is a rare renal anomaly. As a distinct encapsulated parenchymatous mass, this free accessory organ has a separate blood supply and excretory duct system. We report on a patient who presented with an acute episode of abdominopelvic pain, secondary to hydronephrosis of a third kidney, situated in the pelvis behind the bladder. Modern diagnostic methods assisted in the conservative management of this well functioning third kidney.

Pain is a major symptom in about 70% of cancer patients [1]. Cancer pain relief is therefore a ubiquitous concern in public health. The guidelines for a three-step treatment as proposed by the World Health Organisation are widely accepted [2]. With this therapeutic strategy, using the WHO analgesic ladder, cancer pain relief can be achieved in a majority of patients [3].

We conducted an investigation of 186 randomly selected acute adult leukemia patients in order to examine how far age and subtype of leukemia can be correlated with survival rate. The diagnosis of leukemia was established by cytochemical and cytomorphological techniques. There was an increased frequency of acute myelogenic leukemias in older patients. The age group of the 61–90 year old showed a significant decrease in the survival rate, but at the same time in this age group there was a higher frequency of leukemia types with poor prognosis. Early deaths were correlated with advanced age of patients. There were no long time survivors (with survival rates longer than 4 years after diagnosis) above the age of 57.

Prolymphocytic leukaemia occurred in two women aged 75 and 57 years, respectively. In both instances the lymphatic cells fulfilled the morphological criteria of the disease picture. In one patient the disease was characterised by immunological and physical methods as being a B-cell lymphoma, in the other a T-cell lymphoma. Acid phosphatase was of special significance among cytochemical studies. While the patient with the T-cell lymphoma died after three months, the one with B-cell lymphoma is still alive 16 months later. Splenectomy resulted in marked improvement in the latter patient's condition and may turn out to be the treatment of choice in prolymphocytic leukaemia.

Es wird uber einen 44jahrigen Patienten mit einem Kappa-Leichtket-tenplasmozytom berichtet, welcher bereits seit 12 Jahren wegen einer Osteoporose mit multiplen Frakturen in Behandlung stand. Zum Zeit

The cellular exudates in skin windows of 10 normal controls, 3 patients with myeloblastic leukemia, 3 patients with acute monocytic leukemia and 4 patients with symptomatic monocytosis were evaluated by cytochemical methods (naphthol-AS-esterase, acid phosphatase, naphthylamidase, sudan-black B) and by immunofluorescence using a specific antiserum against human lysozyme. Monocytes and derived cells were identified by their content of characteristic NaF (1.5 mg./ml.) -sensitive naphthol-AS-esterase, whose presence was demonstrated by a double incubation method. After an initial decrease, corresponding to degranulation, the acid hydrolases appeared again in the Golgi zone. Macrophages with NaF-sensitive esterase and strong lysosomal enzyme activities became apparent after 12-16 hours, and there was no indication of a development of these cells from lymphocytes. In myeloblastic leukemia and symptomatic monocytosis the cellular exudate was comparable to that of normal humans. In monocytic leukemia an early exudation, predominantly of monocytoid cells, (instead of granulocytes) was a consistent finding. The transformation of monocytoid cells to typical macrophages with an increase of the lysosomal enzymes occurred with enzyme activities remaining lower than in normals.

In den „Rundzelleninfiltraten“ bei chronischen und persistierenden Hepatitiden last sich auf Grund histochemischer Untersuchungen (unspezifische Esterase mit Naphthol-AS-Acetat mit und ohne NaF-Hemmung, saure und alkalische Phosphatase, Naphthol-AS-D-Chloroacetat-Esterase, Sudanschwarz B-Farbung, Perjodsaure-Schiff-Reaktion (PAS) und Methylgrun-Pyronin-Farbung) folgender Befund erheben: In den Zentren der entzundlichen Infiltrate liegen Ansammlungen von Lymphocyten, welche den hauptanteil der Infiltrate ausmachen. Die Infiltrate wachsen peripher durch eine Abschmelzung von Leberzellen. Die v. Kupfferschen Zellen bleiben bestehen und werden in die Randbezirke der Infiltrate einbezogen. In diesen Bezirken finden sich haufig auch einige Neutrophile und wenige Monocyten. Auch Plasmazellen lassen sich uberwiegend in diesen Bereichen nachweisen. Schlieslich konnen noch Venolen und Gallecapillaren identifiziert werden. Eine Beteiligung von Fibroblasten last sich nicht sicher erfassen.

Four cases of acute myelogenous leukemia characterized by peculiar leukemic cell populations are presented. The cytochemical, ultrastructural, biochemical, and functional features Electron microscopy

The usefulness for clinical purposes of the distinction of acute undifferentiated (AUL) and acute lymphocytic leukemia (ALL) is suggested by the following observations: 1. Maturation from AUL to ALL has not been observed. Transformation of ALL to AUL has been reported i.e. less of cytoplasmic polysaccharides; however this seems rather to be the effect of cytotoxic therapy and not a real change of the cytological type. 2. Significant differences among ALL and AUL can be noted as far as the therapeutic response is concerned: All of the 9 patients with ALL but only 2 out of 9 patients with AUL went into remission. The mean survival of the cases with ALL amounts to 34, that of AUL only to 4 months. Out of the patients with ALL 4 patients are still alive in persistant first remission after 77, 57, 36 and 28 months. 3. ALL occurs most frequently in young adults (mean age of 21 patients: 31.7 years): AUL is more frequent in elderly patients (Mean age of 18 patients: 57.6 years). 4. In our material ALL did never occur consequent to a typical preluekemic stage, which was followed either by myeloblastic, monocytic, erythroleukemic or undifferentiated leukemias.

In 47 patients with acute lymphoblastic leukemia surface markers were evaluated on mononuclear cells of the peripheral blood as well as in some cases on bone marrow lymphocytes. The lymphocytes were characterized by their binding capacity for sheep red blood cells, the demonstration of Fc-receptors, complement receptors as well as surface immunoglobulins. In 6 of 23 untreated patients the blasts bound sheep red blood cells spontaneously (T-ALL), in two of these six cases the lymphoblasts had simultaneously receptors for complement. In a further patients the lymphoblasts had complement- and Fc-receptors. The blasts of 16 of 23 patients were negative in respect to the markers tested (O-ALL). By comparing two groups of patients--one with positive cells, one unreactive--the clinical features differed: the marker positive group showed a predominance of male patients, 5 of 7 patients had a massive mediastinal mass and the remission rate was lower than in the group with positive blasts. 24 patients in remission under maintance treatment had a decreased percentage of rosette forming lymphocytes as well as lymphocytes with surface immunoglobulins and Fc-receptors. There existed some correlation between the percentage of rosette forming lymphocytes and the clinical course: patients with complications had lower percentages of rosette forming lymphocytes than patients with a favourable course.

This study comprises 187 patients aged over 15 years with acute leukaemia, diagnosed and treated between the years 1969 and 1978. Fourteen (7.5%) survived for more than 5 years after diagnosis. In this group of survivors there were 7 patients with AML and 6 with ALL--corresponding to 8.9 and 21.4% of each collective, respectively--and 1 patient with PML. Four patients (28.6%) died after a survival time exceeding 5 years, 1 patient with AML as a result of a gastric carcinoma and the 3 other patients (1 AML, 2 ALL) of the original disease. Hence, survival times over several years do not necessarily mean real cures. From an analysis of our data, no factor correlating with long-term survival was identifiable. In terms of clinical-diagnostic parameters the group of late relapses was also heterogeneous.

Prolymphocytic leukaemia occurred in two women aged 75 and 57 years, respectively. In both instances the lymphatic cells fulfilled the morphological criteria of the disease picture. In one patient the disease was characterised by immunological and physical methods as being a B-cell lymphoma, in the other a T-cell lymphoma. Acid phosphatase was of special significance among cytochemical studies. While the patient with the T-cell lymphoma died after three months, the one with B-cell lymphoma is still alive 16 months later. Splenectomy resulted in marked improvement in the latter patient's condition and may turn out to be the treatment of choice in prolymphocytic leukaemia.

Hairy-cell leukemia has been shown to be extraordinary sensitive to treatment with alpha-interferon. In order to define clinically effective interferon doses associated with minimal toxicity two different dose regimens were applied in this clinical trial: firstly, a conventional dose schedule, and secondly, a biologically defined dose regimen. For dose finding in the latter group, neopterin, a GTP degradation product produced by macrophages under control of interferon, was chosen. Six patients (Group A) received conventional doses of recombinant interferon--alpha-2 (rIFN-alpha-2) 3 X 10(6) U/sqm/daily by the subcutaneous route. Five patients (Group B) were treated with the minimal dose of rIFN-alpha-2 which had previously been shown to induce maximum neopterin levels in urine. Already interferon doses in the range of 3 to 5 X 10(5) U/sqm2/daily administered subcutaneously proved to be sufficient for triggering maximum neopterin excretion in the urine. After six months of interferon treatment all patients were evaluable. At this time both doses regimens proved to be effective in terms of their anti-leukemic activity, but differed significantly in toxicity, which was only seen in Group A patients.

The authors report on 16 cases of either subacute (SMML) or chronic (CMML) myelomonocytic leukemia as well as chronic monocytic leukemia (CMoL). All these cases were oligoblastic and, according to their clinical course, they could be termed as smouldering leukemias. The chronic types affected mainly males. The diagnostic cytomorphological and cytochemical criteria are discussed. Erythro- and thrombocytopoiesis were distinctly less impaired than in acute leukemias (AL). The leucocyte count in the peripheral blood of the SMML cases was within the normal range. Hepato- and splenomegaly were markedly increased as compared to AL. According to our materials leukemic skin infiltrations were less frequent in CMoL, CMML and SMML than in acute monocytic leukemias. In each of the three types of leukemia discussed monocytic leukemic cells could be readily identified by cytochemical tests and usually showed fairly normal maturation. In accordance with these observations lysozyme levels in urine and serum usually were strongly increased. The patients in the CMML and CMoL groups showed a mean survival of more than 13 months (2 out of 7 are still alive), whereas the SMML patients survived an average of 8 months. Deaths were frequently due to advanced age rather than to leukemia. In other cases a terminal accumulation of blasts marked a transition to acute leukemia. During the smouldering phase of the disease no beneficial effect of combined chemotherapy could be noted. Supportive and symptomatic therapy might improve length and quality of survival.

A long-term survival study was carried out in a group of 28 adult patients with acute lymphathic leukemia. The complete remission rate was 67.8%, the 50% survival rate is 21.5 months and 41 months in those with complete remissions. Six of 28 patients are long-term survivors and are living at least 5 years after diagnosis. There was a significant majority of female patients among the long-term survivors, with a female to male ratio of 4:2. The 50% survival rate of female patients (n = 11) was 42.5 months and thus considerably higher compared with the corresponding male patients (n = 17, 50% survival rate 7 months). No further clinical or hematological parameters of prognostic relevance were found as a common feature of the long-term survivor group.

This paper reports the case of a 55-year-old patient with complete obstruction of the aorta between the left common carotid artery and the left subclavian artery. The arterial blood supply to the lower half of the body is provided by extensive collateral networks in the region of the right hemithorax, the neck and the base of the brain. Only 10 similar cases appear to have been described in the literature; our patient seems to be the oldest so far.

We refer to 48 adult patients suffering from acute myeloblastic leukemia, whose leukemic cells showed a typical cytochemical pattern: i.e. weak staining for peroxydase and with sudanblack B and lacking or only weak staining for nonspecific esterase. In 8 patients the leukemic myeloblasts additionally showed distinct granular staining for polysaccharides using the PAS-reaction. The therapeutic response, the remission rate and the survival time of these 8 cases have been compared to those of 40 patients, whose leukemic myeloblasts differed exclusively in the absence of granular PAS-positive materials. Out of the latter PAS-negative cases 7 patients (18%) went into a complete remission (M1, P1), 5 patients achieved partial remission (M2, P1-2), the 50%-survival time was 4.9 months. Out of the 8 granular PAS-positive cases 4 patients (50%) went into complete (M1, P1), and 1 reached partial remission (M2, P1-2). The 50%-survival time of the cases now lasts 10.1 months and three patients are still alive and in persisting complete remission 19, 12.5 and 12 months after diagnosis. These results suggest a better prognosis and an improved therapeutic response in those myeloblastic leukemias which additionally contain cytoplasmic granular PAS-positive materials.

The present investigations confirm and extend previous reports on the occurrence of cytochemical anomalies among the hemopoietic cells in preleukemia. The cytochemical patterns of the hemopietic cells obtained from 19 patients suffering from a preleukemic disorder have been studied. The diagnostic value of the cytochemical examination using a panel of 10 different tests is emphasized. In a prospective study in 17 out of 25 patients, preleukemia had been correctly diagnosed. In 4 patients leukemia developed within 2-4 months from the diagnosis ('imminent leukemia'), in 13 patients leukemia or smouldering leukemia developed between 4 and 25 months after the diagnosis ('true preleukemia'). The cytochemical profiles of the hemopoietic cells of the latter have been compared with those of 14 patients suffering from aplastic anemia. In preleukemia the blasts did not exceed 3% of the nucleated bone marrow cells. The clinical value of the diagnosis 'preleukemia' is discussed as well as the prognosis and the possible therapeutic approaches.

Hairy cell leukemia (HCL) has been shown to be extraordinarily sensitive to treatment with alpha-interferon (IFN). In order to define clinically effective IFN doses associated with minimal toxicity, the therapeutic efficacy and side effects of recombinant IFN-alpha-2C treatment of HCL were compared for two different dose regimens: 18 patients (group A) received conventional doses of recombinant IFN-alpha-2C (2 x 10(6)U/m2) for a median time of 35 weeks (range 26-52 weeks), and 21 patients (group B) received optimum biological response-modifying doses of IFN-alpha-2C (0.2-0.6 x 10(6)U/m2) for a median time of 31 weeks (range 12-52 weeks). Interferon was administered daily subcutaneously for 3 months and then every second or third day. Induction of neopterin excretion was chosen as the marker for definition of biological response. The smallest IFN dose causing maximum in vivo induction of biosynthesis of the GTP-degradation product neopterin was deemed "biologically optimal." Both dose regimens were effective, but the low-dose regimen was almost free of toxicity. Thus, in HCL patients alpha-IFN related toxicity can be separated from its antineoplastic activity. Low doses of alpha-IFN should be considered for treatment of HCL patients who develop toxic side effects and for primary treatment of HCL patients with severe cytopenia.

We conducted an investigation of 186 randomly selected acute adult leukemia patients in order to examine how far age and subtype of leukemia can be correlated with survival rate. The diagnosis of leukemia was established by cytochemical and cytomorphological techniques. There was an increased frequency of acute myelogenic leukemias in older patients. The age group of the 61-90 year old showed a significant decrease in the survival rate, but at the same time in this age group there was a higher frequency of leukemia types with poor prognosis. Early deaths were correlated with advanced age of patients. There were no long time survivors (with survival rates longer than 4 years after diagnosis) above the age of 57.

The index of the leukocyte alkaline phosphatase activity (LAP-I) was evaluated in 15 patients suffering from chronic uremia immediately before and after hemodialysis, as well as 16 or 18 and 40 or 42 hours thereafter. Immediately following hemodialysis the LAP-I was significantly reduced in comparison with to predialysis values. 16 and 18 hours after hemodialysis the LAP-I had again increased and at 40 and 42 hours exceeded the starting predialysis values. These results are discussed in relation to the dialysis-induced decrease of plasma cortisol and to the consequent ACTH and cortisol overproduction.

Among 17 patients with non acute monocytic (CMoL) and myelomonocytic leukemia (CMML) one patient presented with atypical findings and an unusual clinical course. Prominent massive pancytopenia had occurred ever since the diagnosis was established. To our knowledge this symptom has not been described in cases with CMML and CMoL. Splenectomy afforded temporary improvement of the anemia but induced sustained, marked thrombocytosis. An unusually prolonged survival time of 44 months was achieved, presumably by the continuous, careful replacement of blood, the splenectomy and the relinquishment of cytotoxic therapy. A gradual, continuously developing blastic crisis and finally the transition to an acute leukemia were observed.

Rhabdomyolysis is usually known to the anaesthetist, who may be confronted with this acute, life-threatening complication during anaesthesia. However, also the medical specialist ought to be familiar with the clinical picture of malignant hyperthermia, since rhabdomyolysis may occur as a late post-anaesthetic complication. Even in oligo-symptomatic and protracted cases of malignant hyperthermia, the case history, electromyogram, exclusion of other possible causes of rhabdomyolysis and, if possible, muscle biopsy contribute to the confirmation of the diagnosis. If a muscle biopsy is not available then a platelet bioassay may substantiate the diagnosis.

A 44 year old man with kappa-light plasmacytoma is presented who had been treated for osteoporosis and multiple bone fractures since 12 years. On admittance he had a rapidly progressive myeloma kidney and an extensive extramedullary tumor within the pelvis. Remission was induced using combination chemotherapy according to the VMCP-protocol. It is discussed that the long-lasting osteoporosis of the present case represents an unusually long, monosymptomatic early stage of a multiple myeloma rather than an independent primary disease.

Zytochemische Untersuchungsmethoden werden bisher in der Hamatologie hauptsachlich fur die Differentialdiagnose der Leukamien verwendet. Es lassen sich jedoch auch bei zahlreichen anderen hamatologischen Erkrankungen bzw. Myeloischen Reaktionen charakteristische, diagnostisch-zielfuhrende zytochemische Befunde erheben. Auf eine Auswahl derartiger Erkrankungen bzw. Markreaktionen soll hier, getrennt nach erythropoetischer, granulopoetischer und monopoetischer Reihe, eingegangen werden.

Cytochemical and immunological studies were performed on "hairy" cells from 5 patients. The results, primarily the detection of surface immunoglobulins after incubation in immunoglobulin-free medium support the hypothesis that hairy cells are B-cells. Further parameters for B-cell lineage are the failing suppression of unspecific esterases by NaF, the presence of tartrate-resistant acid phosphatase and the absence of phagocytic capacity and glass adherence (skin window). A lysozyme could not be demonstrated. Of two patients with prolymphocytic leukemia one was characterized as T- and one as B-cell leukemia. Therefore, the prolymphocytic leukemia has to be discussed as intermediate form of ALL and CLL. In both patients the therapeutic results were discouraging with cytostatics (e. g. chlorambucil), splenectomy is considered as the treatment of choice.

Normal coronary vessels and an akinetic anterolateral wall segment were found in a 24-year-old patient on angiography 10 months after a clinically established myocardial infarction. As the patient had been on a high-dosage medication with ergotamine for two years and as all risk factors for coronary sclerosis as well as evidence of other cardiac diseases were lacking, it seems appropriate to assume that myocardial ischaemia had been caused by coronary spasms.

Cytochemical investigations are useful for the characterization of different kinds of macrocytic anemias. Vitamin B12 and folate defects or chronic alcoholic myelopathy, induce in the erythroblasts cytochemical patterns which can be distinguished from those seen in preleukemia, erythroleukemia, or in drug induced toxic anemia. Tests for alpha-naphthol-acetate-esterase, for acid phosphatase, for iron, and for polysaccharides (PAS-stain), are especially valuable for these diagnostic procedures.

We investigated the effect of human recombinant DNA-derived IFN-alpha-2 given in a dose of 1-2 X 10(6) units daily by subcutaneous injection to five patients with advanced idiopathic myelofibrosis (IM). Transfusion dependent anemia and symptomatic splenomegaly were taken as inclusion criteria for this pilot study. Two patients succumbed, one and three months after starting interferon-treatment because of pneumonia and traumatic cranial injury, respectively. While on IFN-treatment no improvement of cytopenia or reduction of splenomegaly was seen in four of the patients. In one patient, however, the requirement for erythrocyte transfusions decreased from 5 to 1.7 monthly upon IFN-treatment. After two, four and six months respectively IFN-treatment had to be stopped in these cases because of progressive thrombocytopenia and/or neutropenia. These observations suggest, that IFN-alpha might be of only marginal value in the treatment of advanced idiopathic myelofibrosis.

Out of 1800 patients examined for valvular heart disease, 19 were found to have the mitral valve prolapse syndrome (MVPS). The relevant literature is reviewed and the epidemiology and aetiology of the disease are discussed. 50% of the patients had a history of endomyocarditis. The special diagnostic value of echocardiography is emphasized. Sudden death (observed in 2 young patients) and the grave complication of bacterial endocarditis (observed in 3 patients and usually caused by Streptococcus viridans) can occur in this condition. Prophylactic therapy with beta-blocking drugs and antibiotics seems warranted. The case history of one patient with MVPS under observation for eight years, who developed bacterial endocarditis from a dental focus is reported in greater detail as a typical case.