Different colony stimulating activity by tumoral ascitic fluid and conditioned media.

The effects of intraperitoneal Ehrlich ascites tumor (ET) growth on the kinetics of hemopoietic stem cells in the host bone marrow were studied using the spleen colony and the soft agar culture techniques. There is a decrease in spleen colony forming capacity of bone marrow of ET bearing mice, whereas in vitro assays of the committed macrophage granulocyte precursors, by the soft agar method, show that in the same circumstances a high yield of granulopoietic colonies can still be obtained. A shift of the CFU-c/CFU-s ratio from 15 to 36 thus occurs. Moreover, ascitic fluid from tumoral mice displays strong activity as CSF on normal mouse marrow, twice as strong as the standard mouse embryo CSF. When conditioned medium from cultures of ET cells (ET-CM) is tested, the pattern of agar colonies obtained is different from the previously obtained pattern of growth kinetics; furthermore many colonies are composed of undifferentiated cells. The hypothesis is suggested that among the variety of known CSF's, the ET-CM represents a unique factor, capable of inducing proliferation of marrow CFU-c, but only limited differentiation.     

Gastric non-Hodgkin's lymphoma after successful treatment of Hodgkin's disease

A patient seen at presentation for Hodgkin's disease (HD) at stage IV B was successfully treated with MOPP. In remission he developed coeliac disease, controlled by dietary measures, but 26 months after the end of chemotherapy a severe dyspeptic syndrome appeared; endoscopy and barium meal suggested the presence of a gastric tumour, which was surgically removed and showed the histological features of a non-Hodgkin's lymphoma, lympho-histiocytic type. Only moderate chemotherapy was given after the operation and the patient obtained a new complete remission which has lasted 3 years so far. It is likely that the immune depression caused by HD itself and the relevant chemotherapy may have favoured the occurrence of both coeliac disease and subsequent gastric lymphoma.     

Six-month and 12-month mental health outcome of medical and surgical patients admitted to general hospital

BACKGROUND: We have recently reported a two-phase study on psychiatric morbidity in a sample of general hospital patients. This paper reports the results of the 6-month and 12-month follow-up of these patients. METHODS: The screening questionnaire was the GHQ-12. The main diagnostic instrument used in the second phase was the CIDI-PHC. All patients who had been interviewed with CIDI-PHC (N = 363) were followed-up and the baseline assessment was compared with the scoring on questionnaires administered in the 6-month postal enquiry and with the psychopathological status at 12-month, elicited with a telephone structured interview. RESULTS: Sixty-two and 87% of patients completed the 6- and 12-month follow-up assessment respectively. The first follow-up indicated no significant decrease in the level of symptoms. The 12-month follow-up interview showed that 23% of males and 40% of females had poor/mostly poor mental health. The logistic model showed that females with a definite ICD-10 diagnosis, admitted to a medical department, who had consumed psychotropic drugs in the previous year, had the most unfavourable outcome. The risk of a poor/mostly poor outcome steadily increased with the severity of the psychopathology during hospitalization. CONCLUSION: In medical and surgical general hospital patients the risk factors associated with a poor mental health outcome are similar to those found in primary care patients. Greater attention should be paid in assessing routinely mental health status of general hospital patients during hospitalization.     

Mast cell leukaemia: evidence for bone marrow origin of the pathological clone

A 57-year-old female patient, admitted for an acute abdominal syndrome, was found to have an extensive proliferation of mast cells both in the peripheral blood and the bone marrow. Cytochemical studies confirmed the mast cell characteristics of the pathological cell population, while the immunophenotype strongly suggested a bone marrow origin of this malignancy. The course of the disease was not affected by antiproliferative treatment and the patient, after progressive general deterioration, died of intractable haemorrhage. On both clinical and haematological criteria it seems possible to distinguish this rare case of primary mast leukaemia from the more common form of tissue mastocytosis with secondary leukaemia.     

Primary polycythaemia: positive diagnosis using the differential response of primitive and mature erythroid progenitors to erythropoietin, interleukin 3 and alpha-interferon

Forty adult subjects were studied with the aim of establishing positive diagnostic criteria in primary proliferative polycythaemia (polycythaemia vera, PPP). These comprised 14 patients with PPP, eight secondary polycythaemia (SP), five idiopathic erythrocytosis, and 13 normal subjects, classified under standard criteria following comprehensive investigation for causes of SP. Erythroid colony formation from peripheral blood in a serum-free system was assayed with the addition of recombinant human erythropoietin (Epo), interleukin 3 (IL3), or alpha-interferon (alpha-IFN). The differential sensitivity of primitive and mature progenitors (BFU-E) was assessed by counting the number of clusters ('sub-colonies') comprising each erythroid burst. 'Endogenous' erythroid colonies were found in both PPP (56%) and controls (17%). In Epo containing cultures, the mean number of clusters per burst was lower in PPP than controls, and the percentage of small (less than or equal to 8 clusters) bursts was higher. In PPP primitive BFU-E demonstrated greater dependence on IL3 than controls, and mature BFU-E greater inhibition by alpha-IFN. These findings suggest an abnormal response to several growth factors, rather than dysfunction of a single growth factor receptor. Regression analysis of these data defined a discriminant of high diagnostic sensitivity and specificity. This discriminant accurately predicted diagnosis in a further nine polycythaemic patients.     

Peripheral blood lymphocyte subpopulations in polycythaemia and thrombocythaemia

Lymphocyte subpopulations from peripheral blood of normal subjects and patients with primary proliferative polycythaemia (PPP), idiopathic erythrocytosis (IE) and essential thrombocythaemia (ET) were separated using antihuman immunoglobulin antiserum for B lymphocytes and the following monoclonal antibodies: OKT3, directed against the general T-lymphocyte subpopulation, OKT4 and OKT8, detecting respectively T-helper and T-suppressor lymphocyte subpopulations, OKM1 reacting mainly with monocytes. A decrease in the number of OKT3+ cells was observed both in PPP and IE, with a particular fall of the OKT8+ (suppressor) cells, so that the T4/T8 ratio was significantly increased (P less than 0.03 in PPP and P less than 0.0005 in IE). The ratio remained normal in samples from ET. OKM1+ cells were significantly increased in PPP (P less than 0.04), but not in IE, while in ET there was a rise in a few cases only. The present data point out some definite changes in the circulating lymphomonocytic cell subsets, which may be of interest in the study of this group of myeloproliferative disorders.