Value of the lymphocyte nucleolar parameters for the estimation of therapy effectiveness in chronic diseases with immune lymphocyte involvement.
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Biomedical subjects
Publications and source records attributed to D Micu.
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In lymphocytes of patients with myasthenia gravis and systemic lupus erythematosus high indices of uridin labelling were very often encountered, similar to those observed in evident malignant diseases such as chronic lymphocytic leukemia and Hodgkin's disease. The electron cytoautoradiographic investigations showed particularly that large sized nucleoli and even the giant ones are sometimes not the result of an RNA-hypersynthesis but of an RNA accumulation. The utility of such data for the therapy with immunodepressing drugs is discussed.
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Cytochemical study of peripheral lymphocytes in 78 diabetic patients and 22 controls included the determination of glycogen (with calculation of the "glycogen score"), lipids and nucleolar RNA (with calculation of the so-called "lymphocyte nucleologram"). All three metabolic components showed marked differences between the diabetes and the controls. Further analysis in terms of sex, patient's age, duration of disease, basic treatment and main complications of diabetes, also showed certain variations of the above parameters but of lesser amplitude. Metabolic alterations of lymphocytes in diabetes mellitus reflect the pathogenic particularities of the disease, and might probably be used as a basis for further practical purposes.
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Lymphocyte reactivity was studied in 210 subjects who had suffered from acute viral hepatitis, distributed into three lots according to the time-interval from the acute disease. The laboratory investigations included: study of the lymphocyte nucleolar apparatus (amount of nucleolar RNA, relative and absolute areas of lymphocyte nucleoli) and determination of the proportion of the rosette-forming B-cells. A marked increase of the nucleolar RNA amounts and of the B-cell count was observed in the lot of patients investigated after one to 10 years from the acute hepatitis, while in those who, after longer periods (more than 10 years) had developed a liver cirrhosis the values of these parameters were lower than normal. It is assumed that such changes could predict, already in the early stages, either the favourable course of the disease or its progress to chronicity; the hypersynthesis of lymphocyte nucleolar RNA would suggest the interference of these cells in the immune disorders implicated in the development of chronic liver disease.
The area of lymphocyte nucleoli (ALN) is a recently imagined method (Micu et al., 1978) which can detect cytochemically the microscopically visible surface of nucleolar RNA, measurable in mu2. The normal ALN value in peripheral blood is 84.4 +/- 9.2 mu2. Using in vitro cultures of PHA-stimulated lymphocytes obtained from 106 patients with various internal diseases, the authors could demonstrate a relationship between the rate of the lymphocytic RNA biosynthesis and the ALN variations, namely that an RNA hyper- or hyposynthesis is accompanied by an increase or a decrease, respectively, of the ALN.
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A group of 100 workers exposed to vinyl chloride (VC) (mean duration of exposure-13.2 years) were subjected to a complex medical examination for the detection of eventual alterations of the biologic parameters, induced by occupational exposure. Leukocyte cytoenzymochemical determinations (lymphocytic RNA--Plenert's method modified by Micu and glycogen--Hotchkiss McManus method), which might give some information on two important metabolic processes--of proteins and of carbohydrates--were performed in peripheral blood smears. Lymphocytic nucleologram and the relative and absolute nucleolar area showed an increase of endolymphocytic RNA, due to the high percentage of binucleolated cells and of spherical macronucleoli. The increase of the endolymphocytic glycogen score in parallel with the duration exposure was in correlation with high titers of serum gamma GT.
The authors present, in the light of their personal experience acquired in the performance of surgical interventions on the trachea (a total of 13 interventions in 11 patients), some particularities of the surgical technique, as well as of the anesthetic procedures capable to improve the immediate and the late results of these interventions. The techniques suggested are aimed at preventing the operatory risks in the surgical procedures on the trachea, which is classified by the authors in three groups: tracheal risks, vascular risks, and anesthetic risks. The validity of these techniques is confirmed by the success of the surgical procedures applied, followed by the definitive recovery of the patients which were operated with the most recent experience of the authors. Two clinical observations are presented: a case of circumferential resection of the trachea in the mediastinal portion for cicatriceal stenosis, followed by termino-terminal anastomosis, and a case of cuneiform resection of the trachea in its supracarenal section for tumoral stenosis.
Clinical, biological, radiological and radioisotope investigations in 224 patients with Hodgkin's disease revealed a great frequency (100 cases, i.e. 44%) of mediastinal and pleuro-pulmonary involvements, most of them in advanced stages of the disease. The predominant histologic types in these cases were mixed cellularity or nodular sclerosis. Evolution and prognosis were improved by combination chemotherapy in COOP courses; X-ray therapy was associated after drug therapy only if absolutely necessary, on limited areas.
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To study the relationship granulocyte alkaline phosphatase (AP)--zinc (Zn) in mixed leukocyte suspensions, the enzyme from 51 mixed leukocyte suspensions was separated and purified. In the pure extract, determinations were carried out for enzymatic activity--using the autoanalyzer LKB 8600--and for Zn content--using atomic absorption spectrophotometry. From the data obtained it resulted that, in agreement with the results in the literature Zn concentration in the mixed leukocyte suspensions from chronic myeloid leukemia, (CML) patients is about half that in the normal controls (0.65 +/- 0.15 as compared with 1.24 +/- 0.15 micrograms/mg total nitrogen). Granulocyte AP separated from normal leukocyte suspensions was found to bind about 95% of the total Zn content, i.e., 1.21 +/- 0.15 micrograms/mg total nitrogen and its enzymatic activity was about 16 U/g total nitrogen. In CML patients the enzyme bound a mean Zn concentration of 0.55 +/- 0.15 micrograms/mg total nitrogen and its mean activity was 2.25 U/g total nitrogen, i.e., about 86% of the normal values found in the controls. The enzymatic activity decreased to zero after only 20 min dialysis with 8-hydroxyquinoleine-5-sulfonic acid (8HC5S) as compared with the 60-80 min in the controls. It can be concluded that the leukemic leukocyte is unable to form the metal-enzyme complex owing to the deficit of the Zn involved in the enzymatic activity.
Granulocyte alkaline phosphatase (GAP) was extracted from the leukocyte suspensions of 15 subjects with chronic myeloid leukemia (CML), determining the Zn content by atomic absorption spectrophotometry. The purified enzymatic preparation was dialyzed against a ZnCl2 solution (.01 mg%) in TRIS-HCl 0.1 M, pH 7.5, for 48 hours. After dialysis Zn concentration and GAP activity reached normal values. This suggests that the GAP molecule isolated from CML subjects is not altered as it is able to receive at most 2 Zn moles responsible for the enzymatic function.
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Investigations on the T and B lymphocyte surface architecture were carried out by means of scanning electron microscopy (SEM) in 102 patients with various chronic internal diseases such as chronic hepatitis, diabetes mellitus, systemic lupus erythematosus, chronic lymphocytic leukemia, a.o. The clinical and biological examination performed in these cases reveled also some cytochemical, biochemical and immune disturbances. Emphasis is laid on the superiority of SEM, as compared with the E and EAC rosette tests, for the identification of T and B lymphocytes. Moreover, by detecting certain cellular anomalies, SEM can provide useful indications regarding the diagnosis, prognosis and therapy of the above mentioned diseases. Association of SEM with other clinical and laboratory investigations can either confirm, disapprove or even enhance the value of the morphological findings by electron microscopy.
Some peculiar aspects of T and B lymphocytes from patients with chronic internal diseases with immune component such as: chronic hepatitis (CH), rheumatoid arthritis (RA), diabetes mellitus (DM), systemic lupus erythematosus (SLE), chronic lymphocytic leukemia (CLL) and others, could be detected using transmission electron microscopy (TEM) or scanning electron microscopy (SEM) in association with cytomorphologic, cytoenzymochemical and/or cytoimmunologic methods. Among the more frequent aspects observed were the change of the T and B lymphocyte balance and the presence of giant nucleoli associated with RNA hyposynthesis. This latter aspect was proved to be a sign of unfavourable prognosis and of resistance to immunosuppressive treatments in diseases such as: RA, SLE and CLL.