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Spontaneous rupture of the spleen in acute granulocytic leukaemia
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T H E COLLEGE O F P A T H O L O G I S T S O F A U S T R A L I A
concentration or MELC). The normal MELC range is then 0.15-0.50pg. with a median value of 0.30pg. Five hundred estimations on industrial workers engaged in the manufacture of car bodies and batteries gave a range of values from 5-130pg./100 ml. and demonstrated, as would be expected, that certain activities involved more exposure to lead than others. However, some which were previously thought to have a low risk of exposure were shown in fact to have quite a high risk. Several workers had values which were regarded as dangerously high. It was also clear from discussions with the workers themselves that these values had probably been present for several years. Measurements on some workers have demonstrated the value of blood lead estimations in the rapid detection of changes in industrial exposure. The effects of blood lead levels in excess of 70pg. on adult tissue and, in particular the nephron, has yet to be elucidated. SPONTANEOUS RUPTURE OF THE SPLEEN I N ACUTE GRANULOCYTIC LEUKAEMIA
RAVICH, R. B., REED,C. S., STEPHENS, F. O., VINCENT,P. C. & GUNZ,F. W. Sydney Hospital, New South Wales Spontaneous rupture of the spleen in acute leukaemia is of extreme rarity. Although the present case was under close observation in hospital, rupture of the spleen presented considerable diagnostic difficulty. The patient, a man of 53 yr., with untreated acute granulocytic leukaemia without obvious splenic enlargement was awakened from sleep by severe epigastric pain. At laparotomy 48 hr. later, a grossly disrupted and fragmented spleen weighing 240 g. was removed. The patient died four days after splenectomy from unexpected cardiac arrest. Histological examination showed subcapsular haemorrhages in a leukaemic spleen. MALARIA I N VIETNAM
BAIRD,C. W. Royal Melbourne Hospital, Victoria During the period September to November 1968 inclusive, there was a severe outbreak of malaria among Australian and New Zealand troops on active operations in Vietnam. Over 300 cases were diagnosed, the vast majority of which were due to P. falciparum. No deaths occurred. Malaria was contracted in spite of full anti-malarial precautions, including paludrine 100 mgm. bed., wearing of long sleeves, use of repellent and nets, etc. Malaria discipline as judged by random urine paludrine estimations and helicopter inspections was good. Diagnoses were made by the screening of thick blood films after Field's staining and confirmation of morphology by thin films stained with Leishman. Some strains of P . falciparum were known to be chloroquin resistant, so P . falciparum malaria was treated with quinine, Daraprim and Dapsone. Quinine treatment was continued for 14 days but because of quinine toxicity (in approximately 10% of patients) manifested about 10 days after beginning treatment, the course was shortened to 10 days in November. Intravenous quinine dihydrochloride was very useful, but was reserved for those with vomiting, a very high fever or a heavy infestation (hyperinfestation was not seen). A number of fever patterns were observed, the commonest being a fall to normal on the second day of treatment with a rise on the third or fourth day to 39" or above-so called 'middle fever'. As a result of this epidemic, Dapsone 25 mg./day was added to the paludrine for malaria chemoprophylaxis. Permission of the Director General of Medical Services, General Gurner, to release this material is gratefully acknowledged. COAGULATION CHANGES FOLLOWING HEPATIC CIRCULATORY ARREST IN DOGS
JACKSON, J. M. & BROCKIS, J. G. Royal Perth Hospital, Western Australia Experiments were described, designed to give information about the base line changes that occur during the anhepatic and revascularization phases of hepatic transplantation procedures. Coagulation studies were carried out in 11 dogs before, during and after a 20 min. period of isolation of the liver from the rest of the circulation. There was no evidence of clotting factor deficiency, thrombocytopenia, excess production of endogenous heparin or raised plasmin levels. Significant and consistent
T H E COLLEGE O F P A T H O L O G I S T S O F A U S T R A L I A
concentration or MELC). The normal MELC range is then 0.15-0.50pg. with a median value of 0.30pg. Five hundred estimations on industrial workers engaged in the manufacture of car bodies and batteries gave a range of values from 5-130pg./100 ml. and demonstrated, as would be expected, that certain activities involved more exposure to lead than others. However, some which were previously thought to have a low risk of exposure were shown in fact to have quite a high risk. Several workers had values which were regarded as dangerously high. It was also clear from discussions with the workers themselves that these values had probably been present for several years. Measurements on some workers have demonstrated the value of blood lead estimations in the rapid detection of changes in industrial exposure. The effects of blood lead levels in excess of 70pg. on adult tissue and, in particular the nephron, has yet to be elucidated. SPONTANEOUS RUPTURE OF THE SPLEEN I N ACUTE GRANULOCYTIC LEUKAEMIA
RAVICH, R. B., REED,C. S., STEPHENS, F. O., VINCENT,P. C. & GUNZ,F. W. Sydney Hospital, New South Wales Spontaneous rupture of the spleen in acute leukaemia is of extreme rarity. Although the present case was under close observation in hospital, rupture of the spleen presented considerable diagnostic difficulty. The patient, a man of 53 yr., with untreated acute granulocytic leukaemia without obvious splenic enlargement was awakened from sleep by severe epigastric pain. At laparotomy 48 hr. later, a grossly disrupted and fragmented spleen weighing 240 g. was removed. The patient died four days after splenectomy from unexpected cardiac arrest. Histological examination showed subcapsular haemorrhages in a leukaemic spleen. MALARIA I N VIETNAM
BAIRD,C. W. Royal Melbourne Hospital, Victoria During the period September to November 1968 inclusive, there was a severe outbreak of malaria among Australian and New Zealand troops on active operations in Vietnam. Over 300 cases were diagnosed, the vast majority of which were due to P. falciparum. No deaths occurred. Malaria was contracted in spite of full anti-malarial precautions, including paludrine 100 mgm. bed., wearing of long sleeves, use of repellent and nets, etc. Malaria discipline as judged by random urine paludrine estimations and helicopter inspections was good. Diagnoses were made by the screening of thick blood films after Field's staining and confirmation of morphology by thin films stained with Leishman. Some strains of P . falciparum were known to be chloroquin resistant, so P . falciparum malaria was treated with quinine, Daraprim and Dapsone. Quinine treatment was continued for 14 days but because of quinine toxicity (in approximately 10% of patients) manifested about 10 days after beginning treatment, the course was shortened to 10 days in November. Intravenous quinine dihydrochloride was very useful, but was reserved for those with vomiting, a very high fever or a heavy infestation (hyperinfestation was not seen). A number of fever patterns were observed, the commonest being a fall to normal on the second day of treatment with a rise on the third or fourth day to 39" or above-so called 'middle fever'. As a result of this epidemic, Dapsone 25 mg./day was added to the paludrine for malaria chemoprophylaxis. Permission of the Director General of Medical Services, General Gurner, to release this material is gratefully acknowledged. COAGULATION CHANGES FOLLOWING HEPATIC CIRCULATORY ARREST IN DOGS
JACKSON, J. M. & BROCKIS, J. G. Royal Perth Hospital, Western Australia Experiments were described, designed to give information about the base line changes that occur during the anhepatic and revascularization phases of hepatic transplantation procedures. Coagulation studies were carried out in 11 dogs before, during and after a 20 min. period of isolation of the liver from the rest of the circulation. There was no evidence of clotting factor deficiency, thrombocytopenia, excess production of endogenous heparin or raised plasmin levels. Significant and consistent