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We analyzed the clinical features of 36 patients homozygous for the Arg 506 to Gln factor V mutation and found a circumstantial event at risk for thrombosis in 29 of the 31 patients with thrombosis. The most frequent predisposing factors were the post-partum period and the use of oral contraceptives in women, and surgery in both sexes. Venous thrombosis recurred in 48% of the patients. One patient had a myocardial infarction at age 33 years, and also had an antiphospholipid syndrome. Homozygous Gln 506 mutation leads to far less severe thrombotic complications than homozygous protein C and protein S deficiencies and does not seem to predispose patients to arterial thrombosis.

In human immunodeficiency virus type 1 (HIV)-1-infected Black people, the circulating p24 antigen is hidden frequently in immune complexes, because of high titers of serum anti-p24 antibodies. In order to evaluate the prognostic values for progression of free and dissociated serum p24 antigen in Black people, sera from 45 HIV-1-infected Black patients, all at non-AIDS stages, were evaluated prospectively for p24 antigen by several assays; circulating free p24 antigen was measured by immunocapture ELISA only (method 1) and with ELAST amplification (method 2), and dissociated p24 antigen determined after glycine-HCl pretreatment of serum, by immunocapture ELISA only (method 3) and with ELAST amplification (method 4). Serum CD4 and CD8 cell counts, beta 2-microglobulin, and total IgA were determined also at least twice a year. Clinical events for AIDS were those included in the 1986 CDC classification for HIV infection. At entry, p24 antigen was found in 3 (6.7%) patients by method 1, in 7 (15.6%) by method 2, in 14 (31.1%) by method 3, and in 22 (48.9%) by method 4. Methods 3 and 4 were more sensitive than method 1 (P < 0.001) and method 2 (P < 0.001). The mean follow-up was 30 months. The free symptom survival times (mean +/- SD months) were significantly lower in patients being p24 antigen positive by method 1 [(+) 33 +/- 27 vs. (-) 61 +/- 15, P = 0.03), but they were similar in patients positive and in those negative for p24 antigen determined by method 2 [(+) 71 +/- 17 vs. (-) 74 +/- 9, P = 0.54], method 3 [(+) 76 +/- 12 vs. (-) 69 +/- 13.2, P = 0.80], and method 4 [(+) 79 +/- 9 vs. (-) 63 +/- 7, P = 0.71]. At 24 months, p24 antigen positivity did not correlate either with CD4 or CD4/CD8 slops, nor with beta 2-microglobulin or IgA variations. By contrast, a CD4 cell count below 200/mm3 at entry was significantly associated with disease progression. In conclusion, dissociated p24 antigenemia does not appear as a useful surrogate marker for progression in HIV-1-infected Black people.

Twenty two patients with transitional cell bladder carcinoma (T greater than or equal to 2 Mo) received 2 or 3 courses of systemic chemotherapy (cyclophosphamide 600 mg/m2, doxorubicin 60 mg/m2, cisplatinum 100 mg/m2) prior to total (18) or partial (18) cystectomy. Response rate was appreciated on the pathologic findings of the surgically removed bladders (pTNM): 5 tumor progression (23%); 8 tumor stability (36%); 3 partial remission (14%); 4 complete remission (18%), 2 pTo after complete transurethral resection (9%). These results lead us to conclude that: the rate of tumor progression and stability was too high. Further experience will require a more effective preoperative treatment; clinical staging dramatically underestimates tumor spread; prognosis of non responders is quite poor: 7 deaths with a maximum follow-up of 6 months.

In a 66-year old man without previous major disease the unexpected finding of pancytopenia on routine blood count during an acute respiratory infection led to the diagnosis of IgG-producing myeloma without radiological bone lesions, associated with partial blastocytosis and abnormalities in granulocyte maturation. No treatment was given. Within 15 days, the circulating blastocytes became more numerous and type M1 acute myeloblastic leukaemia was diagnosed. A combined rubidazone and cytosine arabinoside treatment failed, and the patient died rapidly.

A total of 483 adult patients with non-leukemic non-Hodgkin lymphomas (NHL) were reviewed for neuromeningeal (NM) involvement. NM involvement was found in 20 patients (4,1%). Presenting complaints were mainly headache (9 cases) or diplopia (8 cases). Cranial nerve palsies were frequent (12 cases). CSF examination was abnormal in 76% of the patients and was the most reliable diagnostic procedure, but abnormal cells were found in only 50% of the cases. The pattern of the lymphoid proliferation was diffuse in 90% of the cases. The most frequent histological subtypes of NHL were diffuse histiocytic (10 cases) and diffuse lymphocytic poorly differentiated (6 cases). In 65% of the cases, the lymphoma was initially disseminated. NM involvement was inaugural in 20% of the cases and was the only site of proliferation in 35% of the cases. Median survival after the NM localization was only 3 months. Long remissions were achieved in 3 patients with isolated NM involvement. These results are compared to previously published data. The indications of CNS prophylaxis are discussed.

Platelet activation (aggregation, serotonin release, TXB2 synthesis) was studied in 8 normal subjects and 5 patients with unstable angina before and after molsidomine treatment. Serotonin release was the most altered parameter after molsidomine treatment in the group of normal subjects. No significant effect could be detected in patients since platelet reactivity varied in a wide range.