Clinical medicine (London, England)
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Lymphocytosis is a common blood-test finding. Establishing whether the cause of lymphocytosis is benign or malignant is key to managing patients appropriately. A lymphocytosis should always prompt clinical review including a thorough history, examination and appropriate preliminary investigations (blood tests, blood film). ⋯ Patient outcomes vary considerably based on genetic pre-disposition and various prognostic markers (age, Binet or Rai staging, and B2-microglobulin). Although not curative, chemo-immunotherapy is an effective treatment strategy for the majority of CLL patients with progressive disease. More recently, novel oral therapies have been developed that target key signalling and apoptosis pathways and that are being used in relapse settings and as first-line treatments for certain patients.
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Comment Letter
The association of pleural effusion and pulmonary embolism.
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Diplopia or double vision is the separation of images vertically, horizontally or obliquely and can be monocular or binocular in origin. Binocular diplopia is most commonly caused by ocular misalignment or strabismus that can be detected using simple clinical tests. All patients with diplopia of acute onset should be investigated urgently and those with a headache or pupillary involvement need to be referred for same-day urgent imaging. Diplopia secondary to microvascular causes on the other hand often spontaneously resolves within six months.