The incidence of hematological malignancies during pregnancy is low, and treatment in this setting is problematic. This study observed 21 pregnancies in 18 patients with hematological malignancies. Patients' ages were between 19 and 43 (median 25) years. Two pregnancies ended with spontaneous abortion, one pregnancy ended with in utero death, three therapeutic abortions were carried out, and 15 infants were born alive but three of them died later. The median birth weight was 2.47 kg. Twelve babies survived to a median age of 36 (range 4-117) months. Eight babies were exposed to chemotherapy during the in utero period. One baby was exposed to chemotherapy during all the trimesters and was born prematurely and later died because of intracranial bleeding. Four babies were exposed to chemotherapy during the first trimester, one of them had low birth weight and floating thumb malformation, two of them had only low birth weight, and one was born healthy, but died at 3 months of age as a result of severe gastroenteritis. Two babies were exposed to chemotherapy during the second and third trimesters; one of them had low birth weight, and the other pregnancy ended in in utero death. One infant was exposed to chemotherapy during the third trimester and was born at term, but died because of pulmonary hemorrhage. We concluded that chemotherapy during all trimesters of pregnancy carries a significant risk for an unfavorable outcome.

Thalidomide may be an effective alternative treatment for BD patients with recurrent and perforating intestinal ulcers despite intense immunosuppressive therapy.

Nonspecific increased inflammatory response is an important feature of Behçet's disease (BD). The skin pathergy reaction (SPR) which tests this hyperreactivity in the skin is frequently used as a diagnostic tool. This study aims to investigate the argon laser photocoagulation (ALP)-induced cutaneous inflammation in BD patients and controls and also to compare the results with the skin pathergy test (SPT). The study group consisted of 35 patients with BD and 28 healthy volunteers. The ALP was applied to the left forearms of all cases from 20-cm distance (2,000 mW, 100 microm) with exposure times ranging from 0.2 to 0.7 s with 0.1-s increments. Also, a SPT with three prics was performed to both forearms of all cases. The ALP-induced cutaneous inflammation and SPT were evaluated and scored with the same method at 48 h, and the SPR scores of 2+ and above was accepted as positive. Positive results as defined above were found in eight cases (23%) with the ALP and in nine (26%) with the SPT in patients with BD. There was no clear correlation between the ALP and SPT results and also between the exposure time to laser beam and SPR scores. The preliminary results of this study reveal that ALP can induce a skin hyperreactivity similar to the needle prick-induced SPR in patients with BD. We, herein, showed that ALP can induce skin inflammation with its thermal effect and without any inoculation of antigen in BD. This method would help to develop another experimental method to investigate the cutaneous inflammation in BD.

We report the case of a woman suffering from Tourette's disorder (TD) who was successfully treated with amisulpride.Case Report. A 40-year-old married woman, at the age of 5, had experienced involuntary head movements, at the age of 8, involuntary leg movements, and, by the age of 12-13 years, vocal tics. During the previous 10 years, the patient had received mirtazapine, buspirone, valproic acid, and sulpride. Only sulpride (chemically related to amisulpride) had a weak effect.The patient was assessed with the Yale Global Tic Severity Scale. 1 Her baseline motor score was 16 (maximum 16), her phonic score 18 (maximum 25), and her impairment score 30 (maximum 50). She was put on amisulpride 100 mg/day. Three weeks later, her scores dropped to 9, 10, and 20, respectively. The amisulpride dose was increased to 200 mg daily, and after another 3 weeks, her scores were 5, 6, and 10, respectively. A further titration to 400 mg/day was made, but without improvement. The patient did not return for follow-up for the next couple of months and, without consulting her therapist, she decreased the amisulpride dose to 100 mg/day without experiencing any deterioration in her condition. For the next 3 months, the patient continued receiving treatment and her condition was stable. Then she decided to discontinue amisulpride because of amenorrhea; within 20 days, the symptoms reappeared. Her scores increased to 10, 11, and 30, respectively. The patient decided to restart amisulpride treatment and simultaneously began seeing a gynecologist for the treatment of amenorrhea.Discussion. As of March 3, 2004, to our knowledge, this is the second report concerning the use of amisulpride in TD, the first being published in French. 2 TD is treated with a combination of agents, and neuroleptics are effective in the treatment of tics. There are several studies on the treatment of TD with newer atypical neuroleptics. Amisulpride reportedly binds preferentially to the limbic system, with very low striatal binding. 3 This unique receptor-binding profile provides amisulpride with some of the clinical advantages seen with the atypical neuroleptics.Our case suggests that amisulpride treatment is effective for treatment of TD at moderate doses (400 mg/day). In our case, the presence of adverse effects is in contrast to the moderate dose and suggests that the patient was highly sensitive to the agent. Thus, future studies should include determination of plasma amisulpride concentrations. The fact that the patient experienced amenorrhea at such a low dose is unusual. 4

In patients with antiphospholipid syndrome (APS), thromboembolism and pulmonary hypertension are the most common pulmonary manifestations. Thrombotic obstruction at the level of the main and/or proximal pulmonary arteries is rare. We report a 40-year-old woman without any history of previous arterial and/or venous thrombosis who presented with severe dyspnea and was found to have pulmonary hypertension and positivity for anticardiolipin antibodies. Computed tomography revealed pulmonary truncus thrombosis extending to both right and left pulmonary arteries. The patient and her family refused surgical treatment. She had a prolonged hospital course, was unresponsive to thrombolytic, anticoagulant, antiplatelet, and immunosuppressive treatments, and died of right ventricle and respiratory failure 5 weeks later. This is the first reported case with thrombosis of pulmonary truncus and main pulmonary arteries concurrent with APS.