Cyclic ultrastructural abnormalities in human cyclic neutropenia

The ultrastructure of neutrophils from two brothers with cyclic neutropenia was studied at various time intervals of the neutrophil cycle, which varied from 15 to 21 days. During the nonneutropenic portion (middle third) of the cycle, when the blood neutrophil counts approached normal, the majority of blood and marrow segmented neutrophils appeared morphologically normal, whereas marrow promyelocytes demonstrated increased autophagy with decreased condensation of primary granules. During the early neutropenic portion of the cycle (first third), increased autophagy and granule abnormalities persisted in promyelocytes, myelocytes, and the few segmented neutrophils present. During the late neutropenic portion (last third) of the cycle, which preceded neutrophil recovery, most promyelocytes appeared morphologically normal, whereas the few segmented neutrophils present frequently contained increased autophagic and/or heterophagic vacuoles and decreased cytoplasmic granules. Abundant neutrophil debris was present in marrow macrophages consistent with dysgranulopoiesis and intramedullary destruction of abnormal myeloid cells. Similar changes were not observed in monocytes, eosinophils, or basophils. These results demonstrate a cyclic insult which has its initial morphologic impact on the promyelocyte of patients with cyclic neutropenia.

Studies on lymphocyte subpopulations and lymphocyte transformation in response to phytohemagglutinin, pokeweed mitogen, concanavalin A in systemic lupus erythematosus

Forty-eight cases of systemic lupus erythematosus (SLE) were studied for lymphocyte subpopulations, and 42 cases were studied for lymphocyte response to mitogen stimulation. A decreased percentage of thymus-derived cells (T cells) and an increased percentage of bursa-equivalent derived cells (B cells), null cells (N cells), double labelled cells (D cells) were found in non-treated cases of SLE. There was no significant difference in these lymphocyte subpopulations in the treated cases in comparison with the normal control. There was an inverted linear relationship between T cells and N cells (p less than 0.001). No such relationship was found between B cells and N cells. The lymphocyte transformation in response to phytohemagglutinin (PHA), pokeweed mitogen (PWM) and concanavalin A (Con A) was expressed in three ways: (1) the net count of transformed data, (2) the difference between the square roots of the isotope incorporation in the stimulated and the non-stimulated cultures (Dsq), and (3) the stimulation index (SI). There were significantly decreased lymphocyte transformation in response to PHA, PWM stimulation in both the non-treated and the treated cases of SLE when results were expressed as net count and Dsq. But decreased counts in response to Con A was only found in non-treated cases. In contrast, no significantly lowered response to all three mitogens was found when data were expressed as stimulation index. Simultaneous study of the percentages of T cells, B cells, N cells, and D cells might be helpful in assessing the clinical activity of SLE and monitoring the effect of therapy. In the study of lymphocyte response to mitogen stimulation, Con A response was a more sensitive indicator of disease activity. The stimulation index was not a good method to demonstrate the result of lymphocyte response to mitogen stimulation in cases of SLE.

A proposed criteria for diagnosis of systemic lupus erythematosus used in Veterans General Hospital

An eight-point diagnostic criteria for SLE was proposed and evaluated at the Veterans General Hospital (VGH), Taipei. It consists of 8 points and 12 items, 3 points being required for an accurate diagnosis. All of 94 cases of SLE whether they could or could not be diagnosed with the ARA criteria fulfilled 3 or more points of the VGH criteria. None of the 17 cases of rheumatoid arthritis fulfilled 3 or more points of the VGH criteria.

Effector and enhancing lymphoid cells in plasmacytoma-bearing mice. II. Dynamic changes during tumor progression

The Winn assay was used for the study of effector (tumor-inhibiting) and enhancing (tumor-promoting) lymphoid cells in BALB/c mice bearing MOPC-104E plasmacytomas. Kinetic studies with thymus, lymphnode, spleen and bone-marrow cells revealed that spleen, lymph node and to a lesser extent bone-marrow cells from 7- and 10-day tumor-bearers inhibited MOPC-104E growth, while at day 13 all three cell populations enhanced tumor growth. However, at day 16 strong tumor inhibition was observed again by spleen cells and to a lesser extent by lymph-node cells and thymocytes. Peritoneal cells from normal and tumor-bearing (7 and 10 days) animals enhanced tumor growth significantly. Separation of spleen cells on nylon wool columns showed that at 10 days the effector cells were T lymphocytes, but at a later stage (35 days) a different effector mechanism was present in the spleen. Treatment of MOPC-104E recipients with carrageenan or silica had little influence on tumor growth, but marked tumor inhibition occurred after lethal irradiation and bone-marrow reconstitution. This latter observation, together with the finding that bone-marrow, lymph node and peritoneal cells from normal donors enhanced tumor growth in several experiments, suggests that this plasmacytoma, like hormone-dependent tumors, requires lymphocyte-derived growth factors.

Serological studies on systemic lupus erythematosus

Serum samples from 73 cases of Systemic lupus erythematosus (SLE) were studied for proteins, immunoglobulins, complement components and anti-nuclear antibodies. In fresh cases of SLE, low serum albumin, high alpha-1, alpha-2, and gamma-globulins were found. Marked elevation of serum levels of IgG was found at the time of diagnosis, but this returned to normal after regular treatment. Over 71% of SLE had serum levels of C3 and C4 lower than normal (mean - 2SD). The more severe the disease, the lower the serum levels of these two components of complement. Fluorescent anti-nuclear antibody (FANA) was found in 98.6% of the cases studied. Most (85.1%) cases and anti-double stranded deoxyribonucleic acid (anti-ds DNA) antibody levels higher than normal control (mean + 2 SD). We may conclude that FANA, C3, C4 and anti-ds DNA anatibody are immunological parameters sensitive in the early diagnosis of SLE. FANA is the most sensitive, and can be used as a screening test in SLE. The serum C3 and C4 levels correlate well with the severity of the disease.

[The value of serum salicylate determination in patients with rheumatoid arthritis (author's transl)]

Thirty-one patients with rheumatoid arthritis in the Veterans General Hospital from July 1978 to June 1979 were treated with acetylsalicylic acid. The serum salicylate level was determined twice a week. The dose of acetylsalicylic acid was adjusted to keep the serum salicylate level around 15-30 mg%. All patients were started with an initial dose of 65 mg/kg/day. The serum salicylate levels at the 4th day varied greatly from 5.6 to 29.5 mg%. Tinnitus was noted in 24 patients. It occurred when the serum salicylate level reached 28.41 +/- 1.84 mg%. Abnormal liver function was noted in 19.35% (6/31) patients during treatment. It returned to normal after withdrawal of acetylsalicylic acid in 3 cases, after decrease of the dosage in 2 cases and on the same dosage in 1 case. Patients with positive FANA and RF were more prone to develop abnormal liver function during treatment. Monitoring of serum salicylate level may decrease the incidence of hepatic toxicity and maintain the dosage of acetylsalicylic acid in optimal range.

Elevated serum ferritin in children with malignancies

Serum ferritin (SF) is elevated in adults with malignancies, chronic inflammatory disease, liver disease and iron overload. The purpose of this study was to determine whether the concentration of SF in children with a variety of malignancies correlated with the activity of their disease. Patients with acute lymphoblastic leukaemia (ALL) at initial diagnosis (n = 11) and relapse (n = 15) had a mean SF of 238 and 338 ng/ml, respectively, compared to the normal mean of 31 ng/ml and range of 7 to 140 ng/ml in children. In 30 patients with ALL in remission the mean SF was 109 ng/ml, less than the values in patients with active disease and greater than the normal mean (P less than 0.001). The concentration of SF was also increased in a group of 77 patients with a variety of solid tumors. The 28 cases with active disease had a mean SF of 242 ng/ml, significantly higher (P less than 0.001) that the value of 84 ng/ml in 49 patients with no evidence of residual tumor. The differences in SF concentration did reflect the activity of disease in the groups as a whole but it remains uncertain whether the assay will prove useful in following the response to treatment of patients with certain types of tumor.

Greenhouse Effects due to Man-Mad Perturbations of Trace Gases

Nitrous oxide, methane, ammonia, and a number of other trace constituents in the earth's atmosphere have infrared absorption bands in the spectral region 7 to 14 microm and contribute to the atmospheric greenhouse effect. The concentrations of these trace gases may undergo substantial changes because of man's activities. Extensive use of chemical fertilizers and combustion of fossil fuels may perturb the nitrogen cycle, leading to increases in atmospheric N(2)O, and the same perturbing processes may increase the amounts of atmospheric CH(4) and NH(3). We use a one-dimensional radiative-convective model for the atmospheric thermal structure to compute the change in the surface temperature of the earth for large assumed increases in the trace gas concentrations; doubling the N(2)O, CH(4), and NH(3) concentrations is found to cause additive increases in the surface temperature of 0.7 degrees , 0.3 degrees , and 0.1 degrees K, respectively. These systematic effects on the earth's radiation budget would have substantial climatic significance. It is therefore important that the abundances of these trace gases be accurately monitored to determine the actual trends of their concentrations.

Differentiation of transient erythroblastopenia of childhood from congenital hypoplastic anemia

Erythrocyte properties of patients with congenital hypoplastic anemia were compared to those of patients with transient erythroblastopenia of childhood. The MCV was less than 85 in all nine TEC patients studied and greater than 90 in all 11 CHA patients. Hemoglobin F concentration was elevated beyond the normal level for age in eight CHA patients and almost always normal in TEC. The i antigen score was more likely to be elevated in CHA than in TEC. The activities of transaminase, aldolase, phosphofructokinase, and glutathione peroxidase were higher in CHA than in TEC (p less than 0.001). Some abnormal properties (namely, MCV and hemoglobi n F concentration) of CHA erythrocytes, present during remission but accentuated during relapse, seemed to vary with changes in serum erythropoietin. Early differentiation of TEC and CHA appears feasible, allowing prompt provision of a favorable prognosis and the avoidance of unnecessary corticosteroid therapy in TEC.

Congenital hypoplastic anemia

CHA, a rare failure of erythrogenesis in infancy and childhood, has been re-examined on the basis of a review of 42 cases of our own and 133 others. Although the disease may have its onset late in gestation, severe anemia usually is not found at birth but, in 75% of cases, becomes apparent within the first 4 months. Associated congenital anomalies include abnormal thumbs, webbed neck and growth retardation. Treatment with corticosteroids as soon as the diagnosis is established induces a remission in 80% of patients. Thereafter, this therapy may need to be continued, often at an extremely low dosage level, sometimes intermittently, for many years before the hemoglobin value maintains itself without medication. Spontaneous remission has occurred in a few cases after years of transfusions. Although it has long been considered that the disease was a failure of normal erythrogenesis manifest by a normocytic normochromic anemia, more exact measurements reveal that the anemia is macrocytic, with MCV usually ranging between 100 and 115 mu3. Other abnormalities of the red cells are present; in general, these resemble characteristics of fetal erythrocytes rather than normal adult cells. These red cell changes may persist even after the patient has been in remission for years, thus representing a permanent abnormality in erythrogenesis.