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The recently described monocytoid B-cell lymphoma is a low-grade lymphoma presenting most frequently in elderly women and commonly associated with autoimmune diseases. Leukaemic expression of this disease has been reported in advanced stages. A case of monocytoid lymphocytosis without lymph node enlargement is presented herein. A 60-year old woman complaining of easy bruises was found to have a 2-cm splenomegaly. Her laboratory data included the following: haemoglobin, 125 g/L; haematocrit, 0.35 L/L; white cell count, 29 x 10(9)/L with 32% PMN, 3% stabs, 2% myelocytes, 1% metamyelocytes, 30% lymphocytes and 32% atypical mononucleated cells showing wide, pale cytoplasm neatly contoured and oval nucleus with monocytoid features. The basal coagulation study showed prothrombin 50%, APTT 40 seconds, fibrinogen 68 mg/dL and FDP between 80 and 160 ng/dL. Splenomegaly without lymph-node enlargement was found on CT scan. The bone-marrow biopsy showed a 68% monocytoid lymphocytic infiltration, acid-phosphatase positive and tartrate-sensitive, without fibrosis. Bone-marrow and peripheral immunophenotype showed those cells to be CD22, CD 19 and CD11 positive, while T and CD25 markers were absent. The patient was treated with alpha-2b interferon at a dose of 3MU three times a week for 6 months, with general improvement and regression of the leukaemic expression. Eleven months after diagnosis she died of a central nervous system haemorrhage. The morphological, immunological and cytochemical features of the monocytoid lymphocytes in this case are commented, along with their variable behaviour. A review of the literature is also carried out, attention being laid on the onset and the response to therapy of B-cell monocytoid lymphomas as the singularity of this case lies on its exclusively leukaemic onset. It is concluded that an interrelationship between monocytoid B-lymphocytic leukaemia and B-cell monocytoid lymphoma might possibly exist, such as that between chronic lymphocytic leukaemia and diffuse lymphocytic lymphoma.

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The effectiveness of a commercial drug containing fibrinogen, thrombin and factor XIL (Tissucol, Immuno) was assessed in 127 patients receiving oral anticoagulant treatment with acenocoumarin who were subjected to 183 minor surgical procedures: 107 exodontia, 53 periodontal procedures, 17 combinations of the former, 4 liver biopsies and 2 skin biopsies. All but the liver biopsies were performed in the outpatient clinic. Mild haemorrhage appeared in 21 instances. None of the patients required systemic administration of coagulation factors, and the maneuvers did not take any longer than in patients with integrity of the coagulation mechanisms. The outstanding benefits of this technique are: less discomfort for patients, who can be subjected to a single procedure while otherwise requiring several sessions; anticoagulation needs not be discontinued, subcutaneous heparin being otherwise necessary; low risk of complications and avoidance of substitutive therapy; lesser economic burden, as no hospital admission is needed.

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A child with acute lymphoblastic leukemia, spinal osteoporosis with vertebral compression fractures, and hypercalcemia appearing early in the course of the hematologic disease was followed for two and a half years. Bone mineral density (BMD), measured by single photon absorptiometry at the radial shaft, was within normal limits for age and sex. However, x-rays of vertebrae and vertebral BMD, measured by dual photon absorptiometry, showed marked demineralization. Despite leukemic remission, the spinal osteoporosis became worse and the patient required aggressive treatment for eight months. Treatment included 50 units of calcitonin subcutaneously every other day, 1,000 mg/day of oral calcium, and 3,000 IU/day of vitamin D. The back pain disappeared quickly, and laboratory controls showed a significant diminution of bone turnover. No new compression fractures occurred. Eighteen months later, the patient continued in remission and menarche had occurred. Dual photon absorptiometry revealed a significant "catch up" of the lumbar spine BMD. X-ray examination showed a marked remodeling of the vertebral bodies. BMD measurements in this child indicate that bone loss affected the trabecular bone compartment or occurred only at active bone marrow sites. The rapid clinical amelioration and objective biochemical, densitometric, and radiologic evidence of bone improvement warrant further clinical trials on similarly affected patients.

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Para obviar incovenientes de la Punción Biopsia Hepática (PBH) transyugular, nosotros efectuamos PBH percutánea en 27 pacientes con hepatopatías crónicas con y sin déficits de hemostasia, utilizando un set de embolización compuesto por agujas de Menghini o tru Cut recubiertas por un catéter, embolizando el sitio de punción con factores de coagulación (I, IIa y XIII). Todos los procedimientos fueron visualizados, midiendo el tempo de sangría hepático, que fue de 0 a 6 segundo en PBH con embolización y entre 2 a 6 minutos para PBH de control. Todas las muestras obtenidas fueron diagnósticas. En nuestra experiencia, la PBH percutánea con embolización del trayecto de salida constituye un método de estudio seguro y eficaz en hepatopatías de alto riesgo

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Para obviar incovenientes de la Punción Biopsia Hepática (PBH) transyugular, nosotros efectuamos PBH percutánea en 27 pacientes con hepatopatías crónicas con y sin déficits de hemostasia, utilizando un set de embolización compuesto por agujas de Menghini o tru Cut recubiertas por un catéter, embolizando el sitio de punción con factores de coagulación (I, IIa y XIII). Todos los procedimientos fueron visualizados, midiendo el tempo de sangría hepático, que fue de 0 a 6 segundo en PBH con embolización y entre 2 a 6 minutos para PBH de control. Todas las muestras obtenidas fueron diagnósticas. En nuestra experiencia, la PBH percutánea con embolización del trayecto de salida constituye un método de estudio seguro y eficaz en hepatopatías de alto riesgo (AU)

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In order to avoid the inconveniences of the trans-jugular liver biopsy, a modified percutaneous liver biopsy with embolization has been performed in 27 patients with chronic hepatic diseases with or without hemostatic disorders. By means of a sheath and a Menghini or Tru Cut needle type, an embolization of the needle tract was carried out utilising coagulations factors (I, IIa and XIII). All procedures were laparoscopically visualised and the "Hepatic bleeding time" measured. With or without embolization, the "Hepatic bleeding time" found was 0-6 seconds and 2-6 minutes, respectively. This modified technic is a safe and effective method for high risk bleeding patients and no hemorrhagic complications postprocedure observed.

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In order to avoid the inconveniences of the trans-jugular liver biopsy, a modified percutaneous liver biopsy with embolization has been performed in 27 patients with chronic hepatic diseases with or without hemostatic disorders. By means of a sheath and a Menghini or Tru Cut needle type, an embolization of the needle tract was carried out utilising coagulations factors (I, IIa and XIII). All procedures were laparoscopically visualised and the [quot ]Hepatic bleeding time[quot ] measured. With or without embolization, the [quot ]Hepatic bleeding time[quot ] found was 0-6 seconds and 2-6 minutes, respectively. This modified technic is a safe and effective method for high risk bleeding patients and no hemorrhagic complications postprocedure observed.

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