Value of small percutaneous bone biopsy in staging lymphoma; experience in a regional hospital

A single small percutaneous bone biopsy was obtained in 107 untreated patients with lymphoma as part of staging. Six out of 52 cases of Hodgkin's disease had positive bone biopsies and three of these relapsed. In 55 patients with non-Hodgkin lymphoma, nine out of 16 with nodular lymphocytic disease and only 12 of 39 with diffuse disease, had positive biopsies. The incidence of relapse and deaths over the time studied was not clearly related to the biopsy results. The results are similar to findings in other series where a larger bone sample was obtained. The value of a single small bone biopsy in lymphoma seems established.

Novel P2X7 receptor antagonists

The synthesis and pharmacological evaluation of a new series of potent P2X(7) receptor antagonists is disclosed. The compounds inhibit BzATP-mediated pore formation in THP-1 cells. The distribution of the P2X(7) receptor in inflammatory cells, most notably the macrophage, mast cell and lymphocyte, suggests that P2X(7) antagonists have a significant role to play in the treatment of inflammatory disease.

Melting glaciers: a major source of persistent organochlorines to subalpine Bow Lake in Banff National Park, Canada

Organochlorine pesticides and polychlorinated biphenyls (PCBs) are ubiquitous and persistent in the environment. They are known to concentrate in cold environments as a result of progressive evaporation from warm regions, and condensation in colder regions. In this study we show that melting glaciers supply 50 to 97% of the organochlorine inputs to a subalpine lake in Alberta, Canada, while contributing 73% of input water. Tritium analyses indicated that during the mid- to late summer warm period, at least 10% of the glacial melt originated from ice that was deposited in 1950-1970, when it was more contaminated with organochlorines. This finding suggests that climate warming may cause melting glaciers to become increasing sources of contaminants to freshwaters. Organochlorines from glacial streams were largely in dissolved form because the organic-poor glacial clays had a limited sorption capacity for the more hydrophobic chemicals.

Arterial thrombosis and accelerated atheroma in a member of a family with familial antithrombin III deficiency

The case is described of a young man with probable familial antithrombin III deficiency, a disorder associated with a marked predisposition to venous thrombo-embolic events. In addition to a history of venous thrombosis and pulmonary embolism, at post-mortem this patient demonstrated widespread arterial thrombosis and atheroma. The probable association of severe arterial thrombosis and atheroma with a clearly definable coagulation disorder predisposing to thrombosis is of interest.

Mycosis fungoides associated with nodular sclerosing Hodgkin's disease: a case report

The possibility of the transformation of mycosis fungoides into a lymphoma of another histologic type is problematic. Convincingly illustrated examples are not to be found in the literature. We report on a well-documented case of a man who developed nodular sclerosing Hodgkin's disease 15 years after first presenting with mycosis fungoides.

Dermatitis herpetiformis and Sjögren's syndrome

Two patients are described with dermatitis herpetiformis and Sjögren's syndrome. The increased incidence of autoantibodies in dermatitis herpetiformis would suggest that this association is significant. Antinuclear antibodies commonly occur in dermatitis herpetiformis (Seah et al,, 1971) yet are rarely associated with autoimmune disease in these patients (Moncada, 1974). This report records two patients with dermatitis herpetiformis and Sjögren's syndrome.

Outcome of sub-total thyroidectomy for thyrotoxicosis in Iceland and Northeast Scotland

A comparative study of the outcome of surgical treatment for thyrotoxicosis was carried out in two countries with dissimilar dietary iodine levels. In the area with a high iodine level (Iceland) the prevalence of post-operative hypothyroidism was five times lower, but recurrent hyperthyroidism was five times higher, than in the area with lower iodine levels (northeast Scotland). The total morbidity reached comparable levels in the two samples. The prevalence of positive thyroid antibody tests and serum thyrotrophin levels was lower and the functional capacity of the thyroid remnant higher in the area with the higher dietary iodine intake. The study provides further evidence that there are important regional differences in the prevalence of factors known to influence the response to surgical treatment of thyrotoxicosis which should be taken into account when planning treatment services.

Thyroid function in normal subjects in Iceland and Northeast Scotland

A comparative study was made of thyroid function in samples of 'well' subjects, from separate geographical areas with dissimilar dietary iodine levels. In the area with the higher iodine level, Iceland, the prevalence of positive thyroid antibody tests and serum thyrotrophin levels were lower, while the capacity of the thyroid to respond to exogenous thyrotrophin was higher than in NE Scotland, an area with lower iodine levels. In contrast the prevalence of positive tests for another organ-specific antibody, gastric parietal cell antibody, was higher in Iceland. These observations are consistent with the reported differences in the incidence rates for thyrotoxicosis and gastric carcinoma in the areas studied. The results are in agreement with our findings in two groups of post-thyroidectomy patients from the same populations. This study provides support for the view that differences in the prevalence of constitutional and environmental factors in different populations contribute to the variation in reported outcome of treatment for thyroid disease.

Non-organ specific autoantibodies in malignant diseases

A significant increase in non-organ specific autoantibodies is demonstrated in13 per cent of the sera from 202 patients with histologically proven malignancies, as compared with only 4 per cent of sera from 214 age and sex matched control patients. It appears that the incidence of autoantibodies is related to the histological type of the tumour but not to the presence or absence of tumour dissenmination. While the control group shows the expected increase in both incidence and titre of autoantibodies with increasing age, the malignant patients show no such pattern i.e. in cancer patients autoantibodies occur with equal frequency and at similar titres regardless of age. The absence of an age related increase in incidence and titre of non organ specific autoantibodies does not appear to have been reported previously. Our findings lend support to the hypothesis that cancer is associated with a breakdown of immunological surveillance, not only in old but also in young cancer patients. Thus the findings of non organ specific autoantibodies, especially to smooth muscle antigen, in an apparently healthy adult could be considered evidence of such a breakdown, carrying with it an increased risk of neoplasia.

Smooth muscle antibodies and alopecia areata

In seventy-eight patients with alopecia areata, the incidence of auto-antibodies to smooth muscle was greater than that in an age and sex matched control population.

Antigen-binding small lymphocytes in the guinea-pig. The immunological response to human thyroglobulin

The time course of the relative distribution of small lymphocytes binding ¹²⁵I-labelled human thyroglobulin (HTg) in cell suspensions from the peripheral blood and various lymphoid organs was studied in guinea-pigs at progressive intervals up to 28 days after immunization with an emulsion of HTg and BCG in Freund's incomplete adjuvant (FIA). Small lymphocytes binding ¹²⁵I-labelled HTg were first detected in peripheral blood, popliteal (draining) lymph node, spleen and bone marrow preparations on the 10th day, and in mesenteric (distant) lymph node and thymus preparations on the 14th day after primary immunization. In general, the percentage of these cells increased progressively thereafter until the end of the period of study. Blocking experiments with unlabelled antigens indicated that the binding of ¹²⁵I-labelled HTg by small lymphocytes was specific. An anti-HTg antibody cytophilic for guinea-pig small lymphocytes was demonstrated by the passive transfer of antigen-binding capacity to lymphocytes of unimmunized animals with hyperimmune guinea-pig serum. It is proposed that, in these experiments, anti-HTg cytophilic antibody was bound first to small lymphocytes in the tissues participating actively in the immune response (popliteal node, spleen and bone marrow) before spilling over into the general circulation to coat lymphocytes at other sites (mesenteric node and thymus).

Antigen-binding small lymphocytes in the guinea-pig. II. The immunological response to purified protein derivative of mammalian tuberculin

A mean of 6.9 per cent of small lymphocytes in peripheral blood preparations and between 1.8 and 2.4 per cent of small lymphocytes in lymph node, spleen, bone marrow and thymus preparations from unimmunized guinea-pigs bound ¹²⁵I-labelled purified protein derivative of mammalian tuberculin (mammalian PPD). The percentage of these cells fluctuated but did not alter substantially after immunization with BCG or with BCG emulsified with human thyroglobulin (HTg) in Freund's incomplete adjuvant (FIA). Blocking experiments indicated that the binding of ¹²⁵I-labelled mammalian PPD was specific and there was tentative evidence that the lymphocyte receptors may be IgG. A comparison is drawn between the observed time course of ¹²⁵I-labelled mammalian PPD-binding small lymphocytes and the response of lymphocytes sensitive to strong histocompatibility antigens, and it is proposed that the propensity of certain antigens to induce a delayed hypersensitivity-type response is related to the presence of substantial numbers of antigen-binding cells in unimmunized animals.

A noteworthy incidental finding was an unexplained depression in the cellular and humoral responses to mammalian PPD in guinea-pigs that had been immunized with HTg—BCG—FIA emulsion.

Antigen-binding peripheral blood lymphocytes in guinea-pigs immunized with human thyroglobulin and BCG

Guinea-pigs were immunized with an emulsion of human thyroglobulin (Tg) and BCG vaccine in Freund's incomplete adjuvant. Peripheral blood lymphocytes binding Tg and purified protein derivative of mammalian tuberculin (PPD) labelled with ¹²⁵I were demonstrated with an autoradiographic technique. The percentage of these cells was compared with the size of the delayed hypersensitivity (DH) skin reactions to Tg and PPD, and Tg antibody titres at intervals up to 35 days after immunization. The individual responses to Tg showed the time course of primary immune reactions although they did not parallel each other closely. By contrast, a depression of cutaneous DH to PPD was observed in spite of the presence of substantial numbers of ¹²⁵I-PPD-binding peripheral blood lymphocytes. In non-immune guinea-pigs, approximately 2·8% of peripheral blood lymphocytes bound ¹²⁵I-PPD whereas <0·1% bound ¹²⁵I-Tg.

The significance of antigen-binding lymphocytes in the immune response is discussed, and it is suggested that the presence of a substantial pool of antigen-binding lymphocytes in unprimed may be of importance in the induction of DH.

Recurrent thyrotoxicosis after subtotal thyroidectomy

A study of patients with recurrent thyrotoxicosis after subtotal thyroidectomy has shown that the operation has a profound effect on the natural history of Graves's disease. It is followed by pronounced changes in the immunological features of the disease, with a fall in the prevalence of serum thyroid autoantibodies, including the long-acting thyroid stimulator. Thyroid suppression returns to normal in 70% of patients. The treatment produces two populations of patients. In the larger group there is a permanent remission of the disease process. In the smaller group the disease process persists and, consequently, recurrent hyperthyroidism may develop. The mechanism of the change in the larger group of patients probably has an immunological basis.

Microangiopathic haemolytic anaemia associated with malignant haemangio-endothelioma

A case of microangiopathic haemolytic anaemia associated with malignant haemangio-endothelioma is described. It is suggested that haemolysis may have been due to mechanical trauma sustained by the red blood cells on passage through the tumour's abnormal vasculature.

Torpidity of freshwater ostracodes

The freshwater ostracode Candona rawsoni Tressler can survive in a torpid state. The time required for rejuvenation of the torpid ostracode depends upon the temperature of the water and the soil-moisture content.