Saturday, August 22, 2009

symptoms

Damage to the bone marrow, by way of displacing the normal bone marrow cells with higher numbers of immature white blood cells, results in a lack of blood platelets, which are important in the blood clotting process. This means people with leukemia may easily become bruised, bleed excessively, or develop pinprick bleeds (petechiae).

White blood cells, which are involved in fighting pathogens, may be suppressed or dysfunctional. This could cause the patient's immune system to be unable to fight off a simple infection or to start attacking other body cells. Because leukemia prevents the immune system from working normally, some patients experience frequent infection, ranging from infected tonsils, sores in the mouth, or diarrhea to life-threatening pneumonia or opportunistic infections.

Finally, the red blood cell deficiency leads to anemia, which may cause dyspnea and pallor.

Some patients experience other symptoms. These symptoms might include feeling sick, such as having fevers, chills, night sweats and other flu-like symptoms, or feeling fatigued. Some patients experience nausea or a feeling of fullness due to an enlarged liver and spleen; this can result in unintentional weight loss. If the leukemic cells invade the central nervous system, then neurological symptoms (notably headaches) can occur.

All symptoms associated with leukemia can be attributed to other diseases. Consequently, leukemia is always diagnosed through medical tests.

The word leukemia, which means 'white blood', is derived from the disease's namesake high white blood cell counts that most leukemia patients have before treatment. The high number of white blood cells are apparent when a blood sample is viewed under a microscope. Frequently, these extra white blood cells are immature or dysfunctional. The excessive number of cells can also interfere with the level of other cells, causing a harmful imbalance in the blood count.

Some leukemia patients do not have high white blood cell counts visible during a regular blood count. This less-common condition is called aleukemia. The bone marrow still contains cancerous white blood cells which disrupt the normal production of blood cells. However, the leukemic cells are staying in the marrow instead of entering the bloodstream, where they would be visible in a blood test. For an aleukemic patient, the white blood cell counts in the bloodstream can be normal or low. Aleukemia can occur in any of the four major types of leukemia, and is particularly common in hairy cell leukemia.

Leukimia

Leukimia
Leukemia (British English: leukaemia) (Greek leukos λευκός, "white"; aima αίμα, "blood") is a cancer of the blood or bone marrow and is characterized by an abnormal proliferation (production by multiplication) of blood cells, usually white blood cells (leukocytes). Leukemia is a broad term covering a spectrum of diseases. In turn, it is part of the even broader group of diseases called hematological neoplasms.


Classification

Leukemia is clinically and pathologically subdivided into several large groups. The first division is between its acute and chronic forms:
Acute leukemia is characterized by the rapid increase of immature blood cells. This crowding makes the bone marrow unable to produce healthy blood cells. Immediate treatment is required in acute leukemia due to the rapid progression and accumulation of the malignant cells, which then spill over into the bloodstream and spread to other organs of the body. Acute forms of leukemia are the most common forms of leukemia in children.
Chronic leukemia is distinguished by the excessive build up of relatively mature, but still abnormal, white blood cells. Typically taking months or years to progress, the cells are produced at a much higher rate than normal cells, resulting in many abnormal white blood cells in the blood. Whereas acute leukemia must be treated immediately, chronic forms are sometimes monitored for some time before treatment to ensure maximum effectiveness of therapy. Chronic leukemia mostly occurs in older people, but can theoretically occur in any age group.

Additionally, the diseases are subdivided according to which kind of blood cell is affected. This split divides leukemias into lymphoblastic or lymphocytic leukemias and myeloid or myelogenous leukemias:
In lymphoblastic or lymphocytic leukemias, the cancerous change takes place in a type of marrow cell that normally goes on to form lymphocytes, which are infection-fighting immune system cells. Most lymphocytic leukemias involve a specific subtype of lymphocyte, the B cell.
In myeloid or myelogenous leukemias, the cancerous change takes place in a type of marrow cell that normally goes on to form red blood cells, some other types of white cells, and platelets.

Hematological malignancy

Hematological malignancies are the types of cancer that affect blood, bone marrow, and lymph nodes. As the three are intimately connected through the immune system, a disease affecting one of the three will often affect the others as well: although lymphoma is technically a disease of the lymph nodes, it often spreads to the bone marrow, affecting the blood and occasionally producing a paraprotein.

Chromosomal translocations are a common cause of these diseases, while this is uncommon in solid tumors. This leads to a different approach in diagnosis and treatment of hematological malignancies.

Although hematological malignancies are a form of cancer, they are generally treated by specialists in hematology, although in many hospitals oncology specialists also manage these diseases. ("Hematology/Oncology" is a single subspecialty of Internal Medicine; there are also surgical and radiation oncologists.)

There are two normal cell lineages from which hematological malignancies derive, myeloid and lymphoid. The former normally produces granulocytes, erythrocytes, thrombocytes, macrophages and mast cells, the latter B, T, NK and plasma cells. Lymphomas, acute lymphoblastic leukemia and myeloma are from the lymphoid line, while acute and chronic myelogenous leukemia, myelodysplastic syndromes and myeloproliferative diseases are myeloid in origin.

Classification and external resources

Food of the Andes by the Golden Gate

SAN FRANCISCO has a well-deserved reputation for restaurant fare that is freshly inventive, but with studiously authentic roots. Gastón Acurio, a celebrity chef in Lima, Peru, known for his novo-Andino cuisine, which adds modern sensibilities about freshness, presentation and technique to the culinary traditions of Peru, took note of this when considering where to open his beachhead restaurant in the United States.

“In San Francisco, people love to eat, and are open to new cultures and flavors,” Mr. Acurio said. “It’s the best place for us to start our dream of bringing our food to America.”

The city’s connection to Peru dates back to Gold Rush days, when pisco, white Peruvian brandy, was the drink of choice. So late last year, Mr. Acurio opened La Mar Cebicheria Peruana (Pier 1 ½; 415-397-8880; www.lamarcebicheria.com), adding to a collection of Peruvian restaurants to make San Francisco perhaps the best place in North America to sample Peru’s rapidly evolving, fervid foodie scene.

A new generation of often classically trained chefs (Mr. Acurio studied at Le Cordon Bleu in Paris) is making wildly creative use of Peru’s diversity. The country’s climate zones range from Amazonian to alpine, nurturing all kinds of foods, and its riot of cultural influences includes Andean, Spanish, Chinese, Japanese and African.

“By nature, Peruvian cuisine is a fusion cuisine,” said Alejandro Reccio, chef de cuisine at Limón, an elegantly boisterous Peruvian restaurant in the Mission District. Limón (524 Valencia Street; 415-252-0918; www.limon-sf.com) was recently closed for remodeling but is reopening soon. Meanwhile, an annex, Limón Rotisserie (1001 South Van Ness Avenue; 415-821-2134; www.limonrotisserie.com), is serving a limited but well-executed menu focusing on pollo a la brasa — rotisserie chicken.

Ceviche, the classic dish of raw fish marinated in lime juice and spices, contains echoes of Inca dishes, but with limes, a Spanish introduction. In its modern form, it arose at the hands of Japanese chefs employed in the kitchens of Peruvian gentry. At Limón, the ceviche de pescado ($9.25) is dependably good; a zingy sauce and delectable choclo (big Peruvian corn) kernels enliven toothsome chunks of halibut.

Limón combines sophisticated interpretations of Peruvian cuisine like this with exquisitely executed, unembellished Peruvian comfort food like pollo a la brasa ($9.50 for a half chicken). Marinated in oregano, cumin and lime, it was tender with a lightly spiced bite. It was accompanied by dipping sauces made with Andean herbs and peppers.

Piqueo’s (830 Cortland Avenue; 415-282-8812; www.piqueos.com), in the Bernal Heights neighborhood, is a red, intimate corner with a small, bustling open kitchen and the friendly vibe that is de rigueur at San Francisco’s Peruvian restaurants. For five years, the chef, Carlos Altamirano, has supplied this quiet neighborhood with daring novo-Andino inventions. They include plates of tequeños ($10), wispy wontons filled with ground squid, fried and dusted in sugar and cinnamon; and pastel de choclo ($10), a mounded torte of choclo and potato alive with peppery watercress.

On a more basic level, numerous small restaurants around San Francisco serve the straightforward fare of Lima’s neighborhoods.

At one such place, Mi Lindo Peru (3226 Mission Street; 415-642-4897), a cheerful, unpretentious space of fake wood paneling and Inca kitsch, the ceviche ($14.95) is a big pile of seafood that with a hoppy Cusqueña lager ($4) could constitute a great lunch on its own. But I followed it up with parihuela ($15.95), a classic Peruvian bouillabaisse overflowing with soft, yielding chunks of fish that contrasted with chewy squid and clam in a rich red broth.

Just up the street, I found Inkas (3299 Mission Street; 415-648-0111; www.inkasrestaurant.com), a lively spot in an old, high-ceilinged bank building, and joined a happy, noisy lunch crowd (including lots of happy, noisy children) for more basic fare: coastal Peruvian dishes as they might be created by a home cook. This meant that classics like ceviche mixto ($14) and pollo saltado (chunks of chicken sautéed with peppers, onions and French fries, $12) were filling without being inspired. Only the anticuchos, skewers of beef heart ($7), really stood out: they were perfectly done, like succulent lean steak, peppery and piquant with a wash of lime.


La Mar, Mr. Acurio’s new establishment, is a big, elegant space overlooking San Francisco Bay. Moody blue light is combined with dark wood and tiles. But flavors seemed to take a back seat to presentation in some of its small plates on the night of my visit.

The ceviches ($16 to $19) were lovely assemblages of fish, but the sauces seemed a little wan. Cebiche Nikei ($17) presented succulent tuna with Japanese cucumber and avocado that only made me miss sushi.

The causas ($11 to $12) at La Mar take the form of delicate cups of suave, cool whipped potatoes of startling hues topped with subtle delicacies, rather than the filling snack that goes by that name in coastal Peru. These causas verged on conceptual: better seen and not tasted.

But the mains were satisfying. Arroz norteño ($24) was smoky, with succulent calamari and sparkling salsa criolla. Cau cau ($31) — roasted scallops with a corn risotto — were succulent and sweet, set free by simple flavors and a pleasant saltiness.

And desserts were stellar: exquisite chocolate bombs called buñuelos ($12), and dessert spring rolls ($10) stuffed with sweet rice pudding and served with bright mango sorbet and fresh mint serving as counterpoint to the elegant crunch.

In the end, it was delightful. Inside La Mar, the crowd grew and the sound rose to a roar. Outside, lights gleamed in the black bay water. And Mr. Acurio’s vision — to make ceviche as known and beloved as sushi — seemed a noble cause indeed.

After Rally to Remember, Murray Will Face Federer

MASON, Ohio — Andy Murray glared at his racket, stared at the lines and complained to the chair umpire, but the truth is he jinxed himself at the Western & Southern Financial Group Masters.
Murray, ranked No. 2 in the world, was like the baseball player who comments on how the innings are flying by, and the next thing he knows the game is going into extra innings. On Thursday, after his second straight-sets victory in two days, Murray noted that his path to the quarterfinals had been the tennis equivalent of the express lane.

“Well, I’ve had two quick matches,” he said, adding, “Yeah, feel pretty fresh.”

On Friday, he needed all the energy he had saved to get past the Frenchman Julien Benneteau, 4-6, 6-3, 6-1. Joining Murray in the semifinals are the other players ranked in the top four: No. 1 Roger Federer, No. 3 Rafael Nadal and No. 4 Novak Djokovic, only the 13th time that has happened on the men’s tour in 25 years.

Murray’s match, played in a mercurial wind, took 2 hours 11 minutes and turned on the longest point of this (or most any) week. It came in the second set, with Benneteau ahead by two games to love and serving at 30-40. He and Murray exchanged 53 shots — four of which were remarkable recoveries by Murray. The last of his desperate lunges produced a lob that Benneteau smashed only to watch with a pained expression as the ball grazed the net and sailed wide.

It was the longest rally either player could remember having in a competitive match. A deflated Benneteau won only two more games.

“It made a big difference” Murray said. “You know, I think he was very tired after that rally.” He added: “He slowed down a lot and he stopped chasing balls that he was chasing in the first set. So you know, I think that point affected him more than me.”

How could it not? Benneteau, a qualifier, had needed more than three hours to dispatch his third-round opponent, Guillermo Garcia-Lopez, and came into the match having already logged 8 hours 38 minutes on the court. He gained entry into the tournament as a lucky loser when Juan Martín del Potro withdrew.

“Yes, I was a little bit tired, for sure, at the end,” Benneteau said. “But it’s because of him. Because he makes me run everywhere, some drop shots, some balls very deep.” He added: “I told myself during the match, ‘Keep going, maybe it can be a semifinal at the end,’ but it’s like that. The best won.”

Murray’s semifinal opponent will be the only player ahead of him in the rankings, Federer, who defeated a former No. 1, Lleyton Hewitt, 6-3, 6-4. After beating Federer in their first three meetings, Hewitt has lost in their last 13.“I understand it’s going to be a very difficult match,” Murray said. “I just look forward to the challenge of playing one of the best ever.”

Murray, who is 6-2 against Federer, knows he will have to play better than he did Friday to make it to his second consecutive final (he defeated del Potro in Montreal on Sunday). “I played a really, really poor first set,” Murray said. “I served really badly.”

He was not exaggerating; he had six double faults against two aces.

On the bright side, to survive and advance without his best stuff was a confidence boost for Murray, who said, “These are the matches that, you know, when you play badly and you don’t feel great and you’re not hitting the ball well, when you can come through matches like that it’s a lot better.”

The Lindner Family Tennis Center crowd appreciated that it did not get any better than a 53-stroke rally. The fans at Center Court stood and applauded both players when it was over. While breathtaking, it came nowhere near the longest point on record, a 643-shot rally between Vicki Nelson-Dunbar and Jean Hepner in a Women’s Tennis Association match in 1984.

Murray was asked if he could imagine being part of a point that long. “I think the game physically has changed so much that, you know, your legs get tired because you’re always changing direction,” he said. “If you’re just sort of moonballing, you don’t get tired because you’re not really putting anything into the shots. So you’ll probably never see a rally like that on the men’s tour.”

SERENA WILLIAMS ADVANCES In Toronto, second-seeded Serena Williams breezed to the semifinals of the Rogers Cup with a straight-sets victory over Lucie Safarova. Williams, the 2001 tournament champion, was rarely challenged in a 6-3, 6-2 victory against Safarova, the 46th-ranked qualifier. Williams will face No. 4 Elena Dementieva, who advanced with a tough three-set win over Samantha Stosur, 6-7 (3), 6-1, 6-3. (AP)

China Mobile’s 2nd-Quarter Profit Slips

BEIJING/HONG KONG, Aug 20 (Reuters) - China Mobile, the world’s largest mobile carrier by subscribers, posted disappointing second-quarter net profit that slipped from a year earlier, hurt by a weak economy and rising competition.v
The firm along with China Unicom and China Telecom — smaller rivals that now compete with a full range of services after last year’s restructuring — are aggressively moving into poorer rural areas as urban markets become saturated.

China Mobile, moreover, will face intensifying competition in the years to come as an expensive 3G rollout gets off to a rough start due partly to a new domestic standard.

The results were announced on Thursday and put the company on track for full-year profit growth of 4.0 percent — based on a Reuters forecast — the slowest pace in a decade after averaging 26.3 percent over the past five years.

“The lack of handsets and poor network infrastructure are the major problem for China mobile’s home-grown 3G rollout,” said Allan Ng,” a BOCI Securities telecoms analyst.

China Mobile will post flat or slightly lower full-year earnings due to competition from the other two other operators, said Ng.

China Mobile posted a 1.6 percent drop in quarterly profit on Thursday, slipping to 30.1 billion yuan ($4.4 billion) versus a consensus forecast of 31.4 billion yuan, according to Reuters calculations based on previously reported figures.

That compared with a restated profit of 30.6 billion yuan for the second quarter of 2008.

China Mobile posted a first-half profit of 55.3 billion yuan, lagging a consensus forecast of 56.6 billion yuan from a Reuters poll of eight analysts.

The profit figures came at the midday stock market break. Its shares were up 1.14 percent in morning trade, and were 15.0 percent higher during the second quarter, short of the 23.9 percent gain by China Unicom and the 20.6 percent rise from China Telecom.

All three trailed the 35.8 percent surge on Hong Kong’s China Enterprises Index over the same period.

3G LOOMS

China Mobile, which controls almost three-quarters of the country’s cellular market, but a big share of new net additions to its subscriber base is coming from poorer rural areas, eroding average revenue per user (ARPU), a key barometer for tracking profitability.

Its margin on earnings before interest, tax, depreciation and amortisation (EBITDA) in the first half was 51.6 percent, falling slightly from a year earlier.

Regulators have said the country’s three carriers will spend $58.5 billion through 2011, building out their 3G networks, with China Mobile set to spend $8.6 billion this year alone on its TD-SCDMA network, a new standard developed in China.

But the new standard is untested and customers are wary of signing on.

China Mobile said last month it had signed up only 1.2 million 3G users and acknowledged it would be difficult to get 3 million by year end, far short of the 10 million the official Shanghai Securities News said the firm had originally targetted.

China Mobile said net additional subscribers in the first half of the year overall was 35.9 million, pushing its subscriber base to 493 million at end-June.

China Telecom, the nation’s dominant fixed-line phone firm, and China Unicom will report earnings next week.

Home of Michael Jackson’s Doctor Raided

As previously reported, Michael Jackson’s person physician Dr. Conrad Murray is being considered as the one who administered the lethal dose of propofol to the late singer. And today his Las Vegas home is being searched by the police.

According to an inside source, “They’re searching Dr. Murray’s residence and office. They’re executing a search warrant. They’re continuing to look for records and other aspects of the investigation. They’re just looking for any information they need to help [in the investigation].”