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The hepatic involvement in Hodgkin's disease, histologically verified in 133 patients who underwent laparotomy or laparoscopy, proved to be singly related to the following clinical findings: result of the liver isotopic scan, liver and/or spleen enlargement, serum albumin less than or equal to 3.5 g/dl, GOT and/or GPT greater than or equal to 20 mU/ml, serum alkaline phosphatase (SAP) greater than or equal to 210 mU/ml, BSP retention at 45 min greater than or equal to 6.5% and ESR greater than or equal to 51 mm at 1 hr. Such clinical findings were jointly evaluated and further selected by means of a logistic discriminant analysis, and the simplest function with the best discriminant ability between involved and non-involved liver was made by liver scan, spleen enlargement, BSP retention and GOT (89.5% of correct diagnoses). Since the Ann Arbor clinical criteria for liver involvement showed correct diagnoses in 69-80% of the cases, more reliable criteria can be proposed. So, liver involvement is highly probably (a) when three or more of the five variables indicated above are abnormal, or (b) when a markedly abnormal liver scan is associated with alteration of at least one of the other four parameters: otherwise liver will be non-involved.

We studied the mechanisms of platelet activation by sublines exhibiting different metastatic potential of two murine experimental tumors: sublines M4 and M9 of the benzopyrene-induced mFS6 sarcoma and sub- lines B77-AA6 and B77–3T3 of RSV-transformed BALB/c 3T3 fibroblasts. The neoplastic cells of both models induced platelet aggregation, secretion and prosta-glandin biosynthesis. In the first model but not in the second, all these processes correlated with the in vivo malignancy of cells. Pretreatment of B77-AA6 and B77–3T3 cells with apyrase significantly decreased platelet aggregation, while pretreatment of M4 cells was ineffective. However, pretreatment with trypsin or neuraminidase was effective in reducing platelet aggregation induced by M4 cells, but not that induced by any of the others; furthermore, phospholipase A2 reduced the platelet response by all sublines. Finally, platelet-activating activity was also found in the pellets obtained following centrifugation of culture media. These results suggest that platelets are stimulated by cancer cells through different mechanisms; platelet activation by a sialo-lipo-protein complex of the cellular membrane was found to be characteristic of the model in which the platelet-aggregating activity of neoplastic cells correlated with their in vivo metastatic behavior.

The plasma-insulin effect detectable by the rat-diaphragm method is conditioned by the length of incubation time. This phenomenon is attributed to variations in the plasma. The causes and the possible practical application of the above observation are briefly discussed.

Pruritus was evaluated with respect to frequency, intensity, and prognostic significance in 360 patients with Hodgkin's disease. In order to discriminate severe from mild pruritus, the following criteria was used: (1) multiple excoriations; (2) ineffectiveness of local and systemic antipruritics; and (3) improvement with either radiotherapy or chemotherapy. Ninety of 360 patients had mild itching on admission and showed the same survival as the 249 nonitching cases; 21 patients presented with severe pruritus, which was also generalized, and showed a statistically shorter survival than that of mild and non-itching cases. This comparison was carried out between patients homologous with respect to sex, age, stage, A or B category, and histotype. Analysis of the data pointed out that the third requirement, i.e., improvement with antineoplastic therapy, is not substantial; moreover, for staging purposes, it is preferably replaced by the requisite of generalized pruritus. The intrinsically poor prognosis related to severe pruritus may be important for treatment, when this symptom occurs in early stages or without other systemic symptoms. The inclusion of severe pruritus among the Ann Arbor criteria for definition of the B-clinical category is proposed.

Summary In autoimmune disorders there is usually only one cell-type involved but occasionally there are more. The cell associated-IgG and -C3 in these disorders are sequestered normally in the spleen and removed by phagocytosis in the reticulum endothelial system (RES). Chronic idiopathic thrombocytopenic purpura (ITP) is an autoimmune disease and normally presents only thrombocytopenia. Infrequently, neutropenia is associated. Recently high doses of intravenous gammaglobulin (HDIGG) have been used to block the cell destruction by RES in these diseases. The patient presented with ITP and associated neutropenia and was treated with HDIGG. We studied some neutrophil function, in relation to therapy (chemotaxis, random migration, latex phagocytosis, NBT reduction, superoxide generation), and performed some cytochemical stains (LAP and myeloperoxidase). We also determined the presence of antiplatelet and antineutrophil functions and resulted in an increase in the platelet and neutrophil count.

Patients suffering from myeloproliferative diseases are frequently susceptible to infection. We studied granulocyte function and cytogenetics in 32 patients with different myeloproliferative syndromes. In vivo granulocyte function was studied in 10 patients using the skin window technique. Our data demonstrate a deficit in chemotaxis (p less than 0.001) which does not seem to correlate with any specific chromosomal anomaly. Patients showing a deficit in myeloperoxidase activity, phagocytosis, O2- production or NBT reduction also had a much lower median survival with respect to other patients treated with the same protocol but without these deficits (p less than 0.01). By conducting granulocyte function studies at diagnosis one may therefore isolate those patients with an increased risk of contracting infections and a decreased probability of complete remission.

The case of a young man with the plasma cell type of Castleman's disease is described. Beyond the well known systemic manifestations the coagulation tests showed a decrease in the activity of factors V, VIII and X due to the presence of lupus-like circulating anticoagulants. After surgical excision of the mediastinal mass both hematochemical pathological data and the coagulation defect disappeared. It is suggested that the lupus-like anticoagulant was secreted by the tumor.

The mechanisms of platelet activation by human tumour cells grown “in vitro” or freshly dissociated from tumour tissues have been investigated.MoCCL human T-lymphoblastic cells cultured “in vitro” induced platelet aggregation through the production of ADP, as evidenced by inhibition of the effect by apyrase. The maximum of ADP production by tumour cells was reached after 1 hour and was 225 p moles/106 cells.On the contrary, platelet aggregation induced by 5637 human bladder carcinoma cells was not inhibited by apyrase, but was abolished by hirudin, indicating the important role of thrombin in this effect.Tumour cells dissociated from 3 breast carcinomas showed a very high platelet aggregating activity, which was not inhibited by hirudin or apyrase, but was abolished by iodoacetic acid, suggesting a role for a cystein-protease in platelet activation.These results confirm that platelets can be activated by tumour cells through different mechanisms; they also suggest that the methods employed to obtain the tumour cells can influence the results, probably because of the different cell populations which are present in the dissociated tumour tissues.Informations obtained with freshly dissociated cells are interesting, because this method has been used seldom so far and because it provides a more physiological approach to the study of the interactions of tumours and platelets.

Prognostic factors were investigated in 67 patients with non-Hodgkin's lymphomas, homogeneously staged and treated (COP or CHOP according to low or high malignant histotype). A large number of parameters were scrutinized in order to recognize those exhibiting a prognostic value regarding length of survival. All the parameters that singly appeared to influence survival were entered into a multiple regression factor analysis. The erythrocyte sedimentation rate (ESR), higher or lower than 35 mm at the 1st h, better discriminated the groups of patients surviving or not at a given time. The histologic type, according to the Kiel classification of malignancy, was the second best prognosticator when a short-term prediction was requested (survival or death after no more than 2.5 years), but showed insufficient statistical weight for predicting longer survivals (greater than 4 years). Stage seemed to be the third best prognosticator for the first years of survival, but only the second best for longer survivals. Other parameters had very low prognostic importance when compared with those above. The results were substantially confirmed by 28 other patients, taken as controls. The importance that such a simple and easy test as ESR may be adequate with regard to prognosis is emphasized.

The plasma obtained from normal subjects theoretically appears the best means of comparison in the isolated rat diaphragm test, particularly as regards its clinical applications. This is practicable because there are usually no significant differences in uptake of glucose for normal plasmas. The choice of normal subjects to donate plasma must be based on age and to a certain extent, biotype. A distinct reduction in the variability of the absolute values of glucose uptake has been observed with this method.

• Owing to improved therapy and lengthened life span, the incidence of neuromeningeal involvement in leukemia is increasing. Careful examination of the cerebrospinal fluid (CSF) is important for an early diagnosis. Among the available techniques, the use of cytocentrifugation enables us to demonstrate central nervous system leukemia even if the white blood cell count in the CSF is under 10/cu mm. We describe the results obtained by examining 631 CSF samples from 87 patients affected by acute leukemia; central nervous system luekemia was found in 22.7% of the patients suffering from acute lymphocytic leukemia and in 6.4% of those with acute nonlymphocytic leukemia (ANLL), but this ratio is higher in ANLL compared with the survival as measured in months (a ratio of 2.0 in ANLL compared with 0.50 in acute lymphocytic leukemia). A "leukemic" CSF was found in 51.5% of prophylactically treated patients and in 73.1% of the untreated ones.