[Present views of lymphocyte growth and differentiation]

In recent years, a large body of information has been accumulated on the origin and differentiation of lymphocytes. According to the present state of knowledge, their ontogeny can be outlined as follows: the pluripotent stem cell originates the lymphatic progenitors, which undergo a series of differentiation events within the microenvironment of the primary lymphatic organs (bone marrow and thymus). Thus lymphatic precursors appear, which finally give rise to mature T- and B-lymphocytes. These events are accompanied by distinct changes in cell markers, mostly surface markers, which have been clearly documented. Some controversy does exist as to whether T and B lineages stem from a common lymphatic progenitor, since recent evidence suggests that B lymphocytes, but not the T, might share a common progenitor with myeloid lineages (hemocytoblast). T-cell maturation starts in the thymic cortex, and under the influence of the soluble thymic factor(s) it progresses in the several post-thymic locations, until final maturation. This process goes from immature (To) to semi-mature (T1) and mature (T2) lymphocytes, these latter mostly characterized by the absence of TdT and by the property to form E-rosettes with SRBC and respond to mitogens. Circulating mature T-lymphocytes display a considerable degree of heterogeneity in terms of functional properties; in this way, various T-subpopulations have been identified on the ground of recognized different properties. The sequence of maturational events of B-lineage takes place within the bursa-equivalent sites. This includes an antigen-independent stage with early B precursors (B0 - B1 - B2), and an antigen-driven maturational phase which actually produces the plasma cells. Among the early B-precursors (B-virgin population), memory cells arise following the antigenic stimulation. Also at that stage, B-cells are highly susceptible to tolerance induction. B-circulating lymphocytes are mainly characterized by S-Ig, Fc receptors, and complement receptors.

Subjective assessment of sexual dysfunction of patients on long-term administration of digoxin

Various data suggest that male patients who have received digoxin on a longterm basis have increased levels of serum estrogen and decreased levels of plasma testosterone and luteinizing hormone (LH). This study was undertaken to investigate the links between the long-term administration of digoxin therapy and sexual behavior, and the effect of digoxin on plasma levels of estradiol, testosterone, and LH. The patients of the study and control group (without digoxin) were of similar cardiac functional capacity and age (25-40 years) and were randomly selected from the rheumatic heart disease patients. A subjective assessment of sexual behavior in the study and control groups was carried out, using parameters such as sexual desire, sexual excitement, and frequency of sexual relations. Personal interviews and a questionnaire were also used for the evaluation of sexual behavior. The findings support the reports concerning digoxin effect on plasma estradiol, testosterone, and LH. The differences in the means were significant. Tests used to evaluate the changes in sexual behavior showed a significant decrease in sexual desire, sexual excitement phase (erection), and frequency of sexual relations in the study group.

Impact of placenta previa on intrauterine fetal growth

The impact of placenta previa on intrauterine fetal growth was studied over a 10-year period, 1968-77. Fetal growth was assessed at the time of delivery by measurement of four parameters--birthweight, length, and head and chest circumferences. For 129 deliveries associated with placenta previa, these parameters were plotted against gestational age on Usher and McLean intrauterine growth curves. Fetal growth was significantly retarded as judged by all four parameters. When the results were analyzed according to the number of vaginal bleeding episodes, different patterns were found for the parameters studied. Retardation in chest circumference was unrelated to gestational age or number of bleeding episodes. Retardation in weight and chest circumference appeared at an early gestational age (25th week) and was more pronounced in the group with repeated episodes of bleeding. Retardation in head circumference and length appeared later (from the 32nd week of gestation) and was also more pronounced in the group with repeated vaginal bleeding. In women who had only one bleeding episode and in whom gestation continued to the 38th week or longer, birthweight, but none of the other three parameters, was consistent with the week of gestation. The results show that birthweight alone is insufficient to estimate intrauterine fetal growth retardation.

Tococardiography in pregnancy during extracorporeal bypass for mitral valve replacement

A 23-year-old pregnant woman with class III rheumatic heart disease, with mitral stenosis, underwent mitral valve replacement with cardiopulmonary bypass during the 32nd week of gestation. Fetal heart rate and uterine activity were recorded during the operation. Transient fetal heart rate decelerations and loss of variability, as well as uterine contractions, were observed during surgery and subsided spontaneously afterward. The pregnancy was carried to term and resulted in a normal infant. Problems associated with maternal extracorporeal circulation during pregnancy are discussed. Long-term effects on the fetus are presently unknown.

Multiple myeloma in husband and wife

An instance of multiple myeloma (MM) in a married couple is discussed, since cases of MM in husband and wife have rarely been observed. The patients were aged 60 when the disease was discovered, and the interval between the diagnosis in the mates was 44 months. Genetic or environmental factors that could have explained the occurrence of myelomatosis were not found in these spouses. Therefore, on absence of a defined cause, our observation, like others previously reported in the literature, should be considered, although exceptional, a chance event.

Effects of a sugar mixture on blood alcohol parameters and impairment in the intact rat

The effects of a sugar mixture containing 43% glucose and 36% fructose on ethanol metabolism and on ethanol-induced impairment were studied in intact rats. When ethanol was given orally mixed with the sugars there was a significant reduction in the area of the blood alcohol time curve accompanied by a decrease in the peak ethanol concentration and a slowing in the rate of ethanol absorption. The whole curve followed a lower course and the time for complete removal of ethanol from the body was markedly reduced even though the slope of the elimination phase (beta) was not significantly increased. Ethanol-induced impairment as measured using a tilting plane device was significantly less when ethanol was given mixed with the sugars and paralleled the reduced area and duration of the blood alcohol curve. The magnitude of the effect observed on blood alcohol levels and impairment was dependent on the dose of sugars administered in relation to the alcohol dose. When the sugars were given orally after absorption and distribution of ethanol were complete the slope of the elimination phase (beta) was increase by 30%. These findings point to an increased rate of ethanol metabolism in rats in the presence of sugars. The action of the sugars prevails only for the first few hours after administration thereafter the rate of ethanol metabolism returns to normal.

Squamous metaplasia of the endometrium. Endometrial response to intrauterine presence of fibroblast-carrying Ivalon sponge

Squamous metaplasia of the endometrium was detected in 3 women out of ten in which fibroblast-carrying Ivalon sponge (produced by implanting the sponge subcutaneously for 6 to 8 weeks) was inserted into the uterus following dilatation and curettage. The experiments were carried out in view of previous successful similar procedures in rabbits to produce fibroblastic bridges inside the uterus, and to avoid the patients from undergoing major surgery (hysterectomy) if possible, and at the same time to use the experiment as a model of contraception procedure. Since no improvement was experienced by the patients, which continued to have excessive blood loss, hysterectomies were performed at a later date, and the specimens were thoroughly examined. The possible effect of the Ivalon sponge (acting as IUCD) on the endometrium is discussed.

Functions of T cells and recruitment of cellular response after in vitro mitogenic stimulation of lymphocytes in chronic lymphocytic leukaemia

In vitro stimulation of peripheral blood lymphocytes from ten patients with chronic lymphocytic leukaemia (CLL) was investigated under various culture conditions. It was confirmed that the mitogenic reactivity of whole cell populations (PBL) was delayed and depressed. When CLL rosette-forming cells (RFC) were stimulated, their 3H-thymidine uptake was increased, but the pattern of the response was similar to that of whole PBL, thus suggesting some impairment of these cells. Furthermore, in order to evaluate the possible recruitment of B cells, generally thought to be unresponsive, some co-culture experiments were performed in which 10(4) normal lymphocytes and 10(5) CLL whole PBL or RFC-depleted cell populations were stimulated with mitogens. An amplified response of the CLL lymphocytes was obtained in all co-cultures, and this effect was more evident when specific T cell stimulants were used; autologous CLL T lymphocytes, on the contrary, failed to display such a 'synergic' effect. These results indicate that normal lymphocytes are able to recruit a large number of CLL lymphocytes in the mitogenic response; furthermore, the fact that in co-cultures of CLL T-depleted fractions a better response was obtained with T cell mitogens suggests that the definition of CLL as a clonal expansion of unresponsive 'B' lymphocytes may be inadequate.

Necrotizing fasciitis

Two cases of necrotizing fasciitis, a disease poorly documented in the gynecologic literature because of its extreme rarity, are described. These are the only cases of this entity seen in our department during the last 24 years. Both patients underwent major surgical procedures for uterine stromal sarcoma and mixed mesodermal tumor. In both, the pathognomonic signs, undermining of the skin, and extensive necrosis of the subcutaneous tissue and the underlying fascia, were present. Later gangrene occurred, and both patients died. The literature is briefly reviewed, which emphasizes the importance of immediate surgery when the disease is recognized. The possibility is suggested that the development of such local processes in cases of mixed mesodermal tumor may be an immunologic reaction and the cultured organisms contaminants.

In vitro proliferative response of chronic lymphocytic leukemia

The peripheral blood lymphocytes of 13 previously untreated chronic lymphocytic leukemia (CLL) patients showed a decreased and delayed response in vitro to plant mitogens (PHA and PWM) and specific antigens (PPD and MLC). In addition, the serum of these patients inhibited the mitotic reactivity of both autologous and homologous normal lymphocytes. Since incubation with CLL serum did not affect the SRBC-rosetting capacity of normal lymphocytes, we believe that CLL serum interferes with some metabolic stage in blastogenesis rather than at the level of mitogen membrane interaction. The in vitro transformation of lymph node, bone marrow and peripheral blood lymphocytes in some of these patients was also investigated. Stimulation of peripheral blood cells with plant mitogens resulted in a more serious impairment of the response than that found with bone marrow and lymph node cells. This could be explained by the fact that, although CLL is a widespread lymphoproliferative disorder, some preferential homing of normally reactive cells in the bone marrow and lymph nodes cannot be excluded. Finally, since no stimulation was observed in mixed leukocyte cultures (MLC), our experiments provide evidence that no antigenic differences are detectable in CLL lymphoid populations.

Ovarian abscess associated with incomplete abortion and intrauterine contraceptive device

A 28-yera-old woman with an intrauterine device (IUD) was admitted to hospital with signs of incomplete abortion. The IUD was removed and curettage revealed necrotic infected decidua with no trophoblastic cells or chorionic villi. The patient subsequently developed multiple abscesses in the right ovary. The mechanism of development of ovarian abscesses in patients with IUD or with infected incomplete abortion is discussed.

Congenital hypoplastic anaemia with unusual dyserythropoietic features. A case report

A case of severe congenital anaemia (Hb levels 3--4 g/dl) is presented. The patient, a 21-year-old female, requires, since the age of two, periodical blood transfusions, but is nevertheless able to lead a normal life as a housewife. Although the case has to be considered as a form of congenital hypoplastic disorder of the erythroid tissue, some of the clinical and haematological features are compatible with a congenital dyserythropoietic state. On the basis of clinical findings it is suggested that it may represent a previously undescribed form of anaemia which shares the features of both hypoplastic and dysplastic congenital affections of erythropoiesis.

Endometriosis mimicking ureterolithiasis

A case of endometriosis obstructing the right ureter is described, with a clinical picture mimicking ureterolithiasis. The usefulness of rapid sequence camera-scintigram in the early diagnosis of ureteral obstruction is discussed.

Tubal and uterine motility in vivo in the rhesus monkey

Previous data indicate that there are definite qualitative and quantitative patterns of tubal activity during the various phases of the menstrual cycle. In the present investigation, the simultaneous activity of the uterus and Fallopian tube was recorded in vivo in mature rhesus monkeys throughout the menstrual cycle. The observations indicate that there are characteristic patterns of both tubal and uterine activity, depending on the various phases of the menstrual cycle. The simultaneous recordings of tubal and uterine activity show that the tubal and uterine contractions are not synchronous or even have a similar pattern. The presence of a transmetrial catheter for recording of uterine activity seems to modify the patterns of tubal activity, particularly during the ovulatory phase. It seems possible that the transmetrial catheter has a similar effect as an intrauterine contraceptive device in this species.

[Unusual case of triple simultaneous complication of duodenal ulcer]

The A.A. report a case of duodenal ulcer observed in a young patient, showing at the same time and associated the three known complications of this disease. After gastric resection, urgently performed, followed a favourable post-operative course and a very good result at distance. On a study of 710 patients with gastric and duodenal ulcer this event occurred once only.

Distribution of concanavalin A receptor sites on specific populations of embryonic cells

The early 32- to 64-cell stage of the sea urchin embryo consists of three cell types, easily distinguishable by size: micromeres, mesomeres, and macromeres. Only the micromeres are migratory. Treatment of dissociated sea urchin embryo cells with fluorescein-labeled concanavalin A (Con A) revealed a Con A-induced highly clustered or capped distribution of receptor sites on the micromeres. Concanavalin A did not induce significant clustering or capping of receptor sites on the mesomeres or macromeres. The results indicate that Con A receptor sites are more mobile on specific population of malignant-like migratory embryonic cells.