Congenital dyserythropoietic anemia (CDA) is a rare group of red blood cell disorders characterized by ineffective erythropoiesis and increased iron absorption. To determine whether growth differentation factor 15 (GDF15) hyper-expression is associated with the ineffective erythropoiesis and iron-loading complications of CDA type I (CDA I), GDF15 levels and other markers of erythropoiesis and iron overload were studied in blood from 17 CDA I patients. Significantly higher levels of GDF15 were detected among the CDA I patients (10 239 ؎ 3049 pg/mL) compared with healthy volunteers (269 ؎ 238 pg/mL). In addition, GDF15 correlated significantly with several erythropoietic and iron parameters including

These data indicate that combined escBEACOPP-ABVD may improve the outcome in patients with high-risk advanced HL. The potential benefit of early-interim PET activity as a guide to continuing therapy in these patients merits further study in the future.

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We for the first time documented high levels of serum s-HJV in CDA I patients, suggesting that it may contribute to iron loading pathology in CDA I and eventually in other anemias with ineffective erythropoiesis.

A prospective 12-month study was conducted throughout 1998 to determine the frequency of selected bacterial zoonoses as causes of fever among hospitalized Bedouins in southern Israel. One or more zoonoses were diagnosed in 30 (27%) of 110 patients admitted with fever. Brucellosis was diagnosed in 9 (8%), rickettsial infections in 20 (18%), and ehrlichiosis in 2 (2%), one of whom had also evidence of rickettsial spotted fever infection. None of the patients was diagnosed with Q fever. Compared with patients without zoonoses, patients with zoonoses were younger (P = 0.01), fewer of them had underlying conditions (P < 0.02), they had a longer febrile period prior to hospitalization (P = 0.04), a significantly higher proportion had arthralgia (P = 0.02), rash (P = 0.03), and splenomegaly (P = 0.04) and a lower proportion had pathological findings on chest auscultation (P < 0.01). Patients with zoonoses were found to have more commonly anaemia (P = 0.03) and leucopenia (P = 0.02) compared to the rest of the study population. Of the 30 patients with zoonoses 60% were misdiagnosed and only 57% received adequate antibiotic treatment. Zoonotic infections are a common cause of fever in adult Bedouins living in southern Israel. Because of the non-specific features of these diseases they are often misdiagnosed. Blood cultures and multiple serological tests should be used in the investigation of fever in such patients and tetracycline should be considered for initial empirical treatment.

The authors assessed the validity of a handcarried cardiac ultrasound device operated by an internal medicine resident for left ventricular geometric abnormalities (LVGAs) in mild hypertensive patients. LVGAs were diagnosed when at least one of the following was present: left ventricular mass index exceeding 125 g ⁄ m 2 and 110 g ⁄ m 2 for men and women, respectively; intraventricular septum thickness P10 mm; posterior wall thickness P10 mm; and left ventricular end-diastolic diameter P5.3 mm. For validation, a cardiologist performed standard echocardiography in all patients. A total of 85 patients completed both echocardiographic studies. LVGAs were diagnosed in 19 (22.4%) cases, 18 of which were confirmed by standard echocardiography. Standard echocardiography did not detect any case of LVGA among the handcarried cardiac ultrasonography LVGA-negative patients. The sensitivity and specificity of the resident's examination were 100% and 98.78%, respectively. Agreement between the two studies was 99% (j 0.97, 95% confidence interval). Hand-carried cardiac ultrasonography may be used as a screening tool for LVGA in hypertensive patients. J Clin Hypertens (Greenwich).