Fettler's disease with smoke inhalation: particles within the lung

In August 1985, a 72-year-old man died in the Manchester air disaster. Transmission electron microscopy of his lung tissue revealed not only inhaled smoke particles, but a large population of distinctive particles with different characteristics. These contain silicon and iron, as well as carbon and oxygen, and are thought to be related to his occupation as a fettler and to the extensive fibrosis seen on routine histology.

Alpha-thalassemia caused by a large (62 kb) deletion upstream of the human alpha globin gene cluster

We describe a family in which alpha-thalassemia occurs in association with a deletion of 62 kilobases from a region upstream of the alpha globin genes. DNA sequence analysis has shown that the transcription units of both alpha genes downstream of this deletion are normal. Nevertheless, they fail to direct alpha globin synthesis in an interspecific hybrid containing the abnormal (alpha alpha)RA chromosome. It seems probable that previously unidentified positive regulatory sequences analogous to those detected in a corresponding position of the human beta globin cluster are removed by this deletion.

Disseminated intravascular coagulation with Fusobacterium necrophorum septicaemia

A 23 year old woman died within six hours of admission from acute disseminated intravascular coagulation. Fusobacterium necrophorum, a Gram negative anaerobic organism, was isolated as a single pathogen from the blood cultures. This association has not previously been reported.

Incomplete Reiter's syndrome following chemotherapy of acute myeloid leukaemia

Reiter's syndrome and other reactive arthritides have been described following infection with various organisms although they can occur in unusual circumstances without an obvious infectious precipitant. We have recently witnessed two attacks of reactive arthritis and keratoderma blenorrhagica occurring in an HLA B27 adult male following chemotherapy on two separate occasions with the same drugs for acute myeloid leukaemia. No attacks occurred before or following the cessation of these drugs. This supports the view that in Reiter's syndrome a common pathogenic pathway is triggered by an 'arthritogenic factor' which in this case appears to have been chemical.

Monosomy 7 and multipotential stem cell transformation

Monosomy 7 was the sole karyotypic abnormality seen in a case of biphenotypic leukaemia involving both the myeloid and lymphoid lineages and in a case of de novo ALL undergoing a phenotypic shift to acute myeloid leukaemia at relapse. These observations suggest that monosomy 7 can be associated with transformation of a common lymphoid-myeloid progenitor cell.

The genetic basis of Hb Q-H disease

A Chinese family has been studied in which two siblings have haemoglobin Q-H disease. Using a combination of haematological and haemoglobin analysis, globin chain synthesis, analysis of alpha/beta globin messenger RNA ratios and restriction endonuclease mapping, it has been shown that each of these siblings has received one chromosome on which both alpha chain genes have been deleted and another on which there is only a single alpha chain locus which carries the alpha Q mutation. Their genotype is thus --/-alpha Q. Despite the fact that the haemoglobin Q mutation in this family is carried on a chromosome with a single alpha chain locus, heterozygous carriers for the variant have only 25% or less haemoglobin Q. Our observations indicate that the molecular basis for haemoglobin Q-alpha thalassaemia is similar to that for the common form of haemoglobin H disease in Orientals. Furthermore, they provide clear evidence that the level of an alpha chain variant in heterozygous carriers is not a reliable reflection of the number of alpha globin genes.

An improved method for the measurement of red cell survival using non-radioactive chromium

An improved technique for the measurement of red cell survival is described in which non-radioactive 50Cr is used in patients for whom radioactive labels are not advisable. The 50Cr was measured by neutron activation analysis using a high resolution germanium (lithium) diode gamma-ray spectrometer. In adult controls, the values obtained were in the range accepted as normal for the 51Cr method, and double labelling experiments showed close agreement. The application of this technique to the measurement of red cell survival in pregnant women suspected of having haemolytic anemia is described.

Measles inclusion-body encephalitis in a child with treated acute lymphoblastic leukaemia

A child with acute lymphoblastic leukaemia, being treated in the UKALL II Trial, had while in remission an attack of measles and made a normal recovery. Four months later she developed an acute encephalopathy and died within two weeks. The brain showed mild inflammatory features and widespread inclusion bodies in neurones and glial cells. Immunofluorescence proved an infection with measles virus. Similar cases have been called SSPE; reasons are given for preferring the term "measles inclusion-body encephalitis".