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The eosinophils of a patient with eosinophilic leukaemia were studied with 13 different cytochemical methods using light and electron microscopy. Apart from the 'left shift' of the eosinophils in bone marrow and peripheral blood, the following morphological changes were noted: uncoordinated maturation of the nucleus and cytoplasm, changes in size of the specific granules, and hypogranulation to such an extent that some of the cells bore only very few granules. The cytochemical studies showed a strongly positive periodic acid Schiff reaction in the eosinophils, caused by a high content of glycogen, and a relatively strong positive acid-phosphatase reaction. These cells were also tested for aryl sulphatase and coenzyme Q. Electron microscopy confirmed the presence of a high-content glycogen and a strong acid phosphatase response in the cells. Peroxidase reaction, detected in electron microscopy as well, enabled us to trace the maturation of the eosinophil cell line. [ABSTRACT FROM PUBLISHER]

A patient is described who developed venous thrombosis in the leg following an intramuscular injection of ergotamine tartrate. [ABSTRACT FROM PUBLISHER]

Ten of 55 patients with chronic myelogenous leukemia (CML) diagnosed between 1972 and 1977 were found to lack the Philadelphia (Ph1) chromosome. Serial clinical, morphologic, and cytogenetic studies of patients with Ph1-negative CML showed that 30% of them had chromosomal abnormalities. Two had an extra chromosome No. 8 at the time of blast crisis, with a morphological picture of myeloblasts in the bone marrow. A third patient had a 6:14 translocation initially Abnormalities of chromosome No. 14 are frequently seen in lymphoproliferative disorders, and the bone marrow and peripheral blood contained a significant population of lymphoblasts as well as myeloblasts. The median survival for the 10 patients was 19 months. The exact nature of Ph1-negative CML is not yet clear; disease appears to be a distinct entity among the myeloproliferative disorders.

Peripheral blood lymphocytes from 20 patients with acute infectious mononucleeosis (IM) were studied for cell aggregation and for cap formation by concanavalin A (Con A). The lymphocytes from these patients showed 5.2+/-1.5% cells with a Con-A-induced cap and a high degree of cell aggregation without Con A, compared to 27.7+/-3.2% caps and a low degree of cell aggregation with normal lymphocytes. The lymphocytes from IM patients were fractionated to enrich for T and B cells. There was a low frequency of cap formation in both T and B cells, but the high degree of celll aggregation without Con A only occurred with B cells. Studies with four patients in clinical remission from acute IM have shown that the frequency of Con-A-induced cap formation only returned to normal more than 3 months after the beginning of clinical remission and that even at 6 months the cells still showed a high degree of cell aggregation. The results indicate that a high degree of B-cell aggregation and a low percentage of B and T cells with a Con-A-induced cap were associated with acute IM and that the changes associated with a high degree of B-cell aggregation were by themselves not sufficient to cause the disease.

We observed chromosome-banding abnormalities in leukemic cells of 46 of 90 (51 per cent) adults with acute nonlymphocytic leukemia at initial hospital admission. The difference in survival between 37 treated patients with an initially normal karyotype (10 months) and 43 with an initially abnormal karyotype (four months) was significant (P less than 0.01). When patients were classified as having acute myelogenous leukemia or acute myelomonocytic leukemia, this difference in survival was even more pronounced. Of 16 treated patients with acute myelogenous leukemia and a normal karyotype, 11 (69 per cent) had a complete remission and a median survival of 13 months. Of eight patients with acute myelogenous leukemia in whom only abnormal metaphases were observed, none had a complete remission, and the median survival was only two months (P approximately 0.50). Remission rate and median survival were not significantly different in patients with acute myelomonocytic leukemia grouped according to initial karyotypes.

Four patients with advanced diffuse histiocytic lymphoma who developed lactic acidosis are described. All four patients demonstrated disturbed liver function tests. In two of the patients, the lactic acidosis was unresponsive to treatment. The third patient responded successfully to the early initiation of combination chemotherapy with achievement of a clinical remission and correction of the lactic acidosis. The fourth patient responded to the initiation of chemotherapy with abatement of his lactic acidosis, but expired probably as the result of a pulmonary embolus. It seems likely that extensive hepatic infiltration may be one of the factors contributing to lactic acidosis in patients with diffuse histiocytic lymphoma. The early initiation of antineoplastic therapy may be important in the management of patients with histiocytic lymphoma and lactic acidosis.

Anemia is a common phenomenon in women during the reproductive years. In pregnancy, it is associated with an increased incidence of maternal-fetal morbidity and mortality. The approach to the investigation of anemic women suspected of having hemolytic anemia of either congenital or acquired etiology is the subject of this article. Various conditions in the pregnant women can have hematologic consequences for the newborn infant; these conditions include sensitization to fetal blood cells, infections, drug ingestion and the possession of genes for hereditary hemolytic disorders, which may be transmitted to the fetus. Because several forms of hemolytic anemias are hereditary or are caused by an altered gene, genetic consultation is important.

A program of combination sequential chemotherapy using cyclophosphamide, vincristine, methotrexate with leucovorin rescue, and cytarabine (COMLA) was administered to 42 previously untreated patients with advanced diffuse histiocytic lymphoma. Twenty-three patients achieved a complete remission as determined by strict clinical restaging criteria. The observed median duration of survival for the complete responders is longer than 33 months. Eight patients achieved a partial response, with a median survival longer than 21 months. Eleven patients showed no response, with a median survival of 5 months. Toxicity was acceptable. None of the responders have shown central nervous system relapse. There was no difference in response rates between patients with stage III or IV lymphoma or between asymptomatic or symptomatic patients. The COMLA program produces a high rate of complete and durable remissions and should be considered as an initial form of management of patients with advanced diffuse histiocytic lymphoma.

Twenty-three episodes of drug-induced agranulocytosis admitted to the Beilinson Medical Center between 1960-1972 are reported. An increased incidence in patients admitted with this condition was noted over the years. Dipyrone (6 episodes in 4 patients) and chloramphenicol (5 episodes in 5 patients) were the drugs most commonly associated with this condition. Four patients died in septic shock. The increased incidence of hospital-admitted patients with drug-induced agranulocytosis is related to the increased use of drugs in the Israeli population.

A patient is described in whom CML first presented as blastic crisis. The diagnosis of CML was based upon the findings of Ph(1) chromosome in the bone marrow, basophilia in the peripheral blood, absence of NAP activity in the leukocytes, elevated serum vitamin B(12) and an enlarged firm spleen. CML with blastic crisis as its first expression is relatively rare, as compared to CML in which blastic crisis appears as a phase of prolonged clinically manifest disease.

A patient with Ewing's sarcoma of the left scapula received prophylactic radiotherapy to the left lung following wide excision of the tumor. While the left lung remained free of tumor, there was metastatic invasion of the right lung within ten months of the initial diagnosis of the disease. Since Ewing's sarcoma frequently metastasizes to the lungs, it is suggested that prophylactic irradiation of the lung may be of value in the prevention of metastases.