Blue: free download. On-line books store on Z-Library Z-Library. Download books for free. PRADAXA increases the risk of bleeding and can cause significant and, sometimes, fatal bleeding. Risk factors for bleeding include the use of drugs that increase the risk of bleeding in general (e.g., anti-platelet agents, heparin, fibrinolytic therapy, and chronic use of NSAIDs), and labor and delivery. Promptly evaluate any signs.
Pathology (1989), 21, October
1.E cells ( t r i t l i neutrophil being the pi-edoniinant phagocyte in peripheral blood), while 1.L cell in-io repreent L E cells (nith macrophages being the predominan[ phagocytes i n pleural fluid) at arious rage of drclopinenr :I far as clinical application I S concerned. thec atbpical LE cells. wheii recognued. should lcad I O a inore thorough search for typical 1 tI cell. Chi-shun Feng Haematology Clinical Pathology Unit Prince o f Wales Hmpilal Shatin. NT Hong Kong
DK.The occurrence of LE cells and heniatoxylin bodies in naturally occurring cutaneous lesions of SLE. Am J Med Sci 1961: 241: 31-43,
I . Wiison RkI, Ahbott KK, filler
1 Seaman A J . Christerson JW. Demonstration of LE cells i n pericardial -.
fluid. .lAMA 19.51: 149: 145-7.
3 . Mctrger .L . Coync 51. ILee S et al. In viio 1.E cell foi-mation perironirik due to SL E . J Rheumatol 1974; I : 130-33.
1. Hunder G G . Pierre R V . In v i v o LE ccll formation i n rynoviai fluid. ,Arrliriti Khcum 1970: 13: 418-51.
5 . Owiiura R Y . Shioya S. Handa K et al. Lupus erlthematosus cells i l l pleural fluid: cytological diagnosis in t u o patient,. Acta Cytol 1977: 21 215.17. 6. IJandya I H , .-pi13. Grady KF. I n ivo L E phenonicnon fltrid. ! i r l i r i t i < Khrurn 1976: 19: 962-3. I.
to he thickened with nodules scattered along its length. This segment
was resected. and on opening, the nodules were seen capped by small hemorrhagic ulcers; microscopic examination showed leukemic (myeloid) infiltration along the submucosa with areas of focal extension into the mucosa and ulceration. Three weeks after surgery his counts showed H b 13g/dl, WBC 10.2 x 109/1(3% blasts) and platelets 145 x 10p/l.Six weeks after surgery he re-presented with sepsis and died despite optimal antibiotic therapy. Autopsy was not done. As Wong et al. have stated,' granulocytic sarcoma (or extramedullary collection of leukemic infiltrates) is rare as the first manifestation of MDS transforming into acute leukemia. However, as illustrated by the present case, even in the presence of another malignancy, such a possibility can exist. A. Manoharan Department of Clinical Haematology St George Hospital Kogarah, NSW 2217
I, Wong KF, Yuen RWS, Lok ASF, Chan TK. Granulocytic sarcoma presenting as bleeding gastric polyp. Pathology 1989; 21: 63-4.
2. Foucar K , Langdon I I RM, Armitage JO et al. Myelodysplastic syndromes: A clinical and pathologic analysis of 109 cases. Cancer 1985; 56: 553-61.
3 . Teerenhovi L. Lintula R . Natural course of myelodysplastic syndromes - Helsinki experience. Scand J Haematol 1986; 36: Suppl 45: 102-6.
heshgegian A,%. Lupu erythematosu$ cell in pleural fluid. Anier I Clin Pathol 1978: 6915): 570-71.
8. C;arnct R t , Atkinson BF. Bonner H. Wurzel HA. Rapid creening for lupui ?trythematostis cells usins cytocentrifuge-prepared huffy coat montdayers. .in .I Cliii Pathol 1977; 67: 237-9.
GASTROINTESTINAL BLEEDING DUE TO LEUKEMIC INFILTRATE IN MYELODYSPLASTIC SYNDROME 1 read, with interest, the report by Wong et al.' describing a patient
with myelodysplastic syndrome (MDS) i n whom the first manifestation of leukemic conversion was bleeding from a polypoid gastric granulocylic sarcoma. Apart from acute leukemia, patients with hIDS may also debelop carcinoma - a recognized cause o f death in 5-10'% of patients.' In this communicatioli I wish to describe a patient with MDS and gastric carcinoma (simultaneous diagnosis). in whom leukemic infiltrates in the small bowel caused recurrent bleeding. A 72-year-old man was first seen in November, 1981, with symptoms of anemia: H b 8.5 g./dl. WBC 4.3 x 10y/l (5'70 blasts), platelets 150 x IOq/l. Bone marrow examination established a diagnosis of MDS (refractory anemia with excess blasts - 8%. RAEB) and iron deficiency. A gastroscopic examination showed irregularity of gastric mucosa; histology showed poorly differentiated adenocarcinoma of stomach. The patient refused wrgery for the gastric carcinoma, and it was decided to treat the >IDS conservatively. Over the next I 2 months, he required frequent admissions for hlood transfusions. On many occasions there was a definite history of melena stools, hut repeated gastroscopic examinations did n o t show any active bleeding and colonoscopy of thececum gave normal resulrs. 'Cr-labelled red cell studies confirmed gastrointestinal bleeding, ranging from 200 ml to 800 ml/day. A TcWm-labelled red cell stud! roealed bleeding into the cecum at two hours. Laparotomy was performed in November, 1982. The cecum was macrorcopically normal and the lesser curvature of the stomach was noted to he indurated. In the proximal ileum a 25 crn segment was found
ROLE OF DIETARY CHOLESTEROL IN ATHEROSCLEROSIS: REPLY TO COMMENTS OF DR J.T. LIE AND DR B.A. KOTTKE At this time of widespread editorial resistance to publication of criticisms of the lipid hypothesis the kind remark of Dr J.T. Lie and Ur B.A. Kottke are appreciated. The M'atanabe rabbit is a n hereditary lipid storage disease akin to t'amilial hypercholesterolemia and has been discussed elsewhere.' The re ieMers are mistaken i n believing that spontaneous atherosclerosis in lower animalr is rare in the absence of cholesferol-feeding. The spontaneous occurrence of atherosclerosis in animals other than man is Hell eitablished and was also dealt with elsewhere.' ' Atherorclerosis occurs i i i mammals including sheep and rabbits and also in birds on low-fat. herbivorous diets and can be produced experimentally i n these animals merely hy altering blood flow.' ' I f one accepts that the rihromusculo-elastic thickenings at arterial forks are an early stage of atheroiclerosii,' and the intimat-injury hypothesis is, after all, a belated epiance of this concept, then atherosclerosis appears to be ubiquitoui in mo5t mammalian and even avian vascular systems s o far examined, including the thoracic duct of man.' Moreover, it is the variation in sewrity of atherosclerosis rather than the incidence of a complication or a specified degree of its severity that should he considered, and genetics is almost certainly intolved, but not because of heieditary lipid metabolic disorders. Variation in cholesterol levels due to methodology still exists as thc recent references i n the bibliography of thc paper reveal. Even it' this holds ti-ue only for old epidemiological tudies, t he findings derived therefi-om require re-evaluation. Reference ranges in I986 varied widely from laboratory t o laboratory.' However, the variability is considetable and due to both analytical and biological factors.' Individual variability in hlood choleitcrol level is pi obably more pronounced i n those w i t h high serum levels. Many of these have a lipid dystrophj and hould he excluded from clinical trial and othri- such studies i f coronary heart disease is the end point sought I did iioi m t c that halt' of all coi.onary heart disease is accounted tor by t'ainilial hqpercliole~tcrolemia.The reference quoted refers t o
Book author: Sara Paretsky
The New York Times bestseller from the author of Fire Sale.In Kansas, three families have coexisted not-so-peacefully for more than one hundred and fifty years: the Grelliers, the Fremantles, and the Schapens. Into their lives comes Gina Haring, a...more details below
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The New York Times bestseller from the author of Fire Sale.
Bleeding Blue The Movie
In Kansas, three families have coexisted not-so-peacefully for more than one hundred and fifty years: the Grelliers, the Fremantles, and the Schapens. Into their lives comes Gina Haring, a relative of the Fremantles who is house-sitting the derelict family mansion while she puts her own life in order. Her lifestyle and beliefs will put her at odds with her neighbors, and test the mettle of a community being swept up in events beyond its control.
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Sara Paretsky is the author of sixteen books, including her renowned V. I. Warshawski novels. Her many awards include the Cartier Diamond Dagger Award for lifetime achievement from the British Crime Writers Association. She lives in Chicago.
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Sara Paretsky grew up in eastern Kansas, where she attended a small country school. The publishing bug bit Paretsky early—at age 11, her first published story appeared in the magazine The American Girl. It was about childreneyond its control.