Biomedical subjects
Publications and source records attributed to H Stein.
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The activity of alpha-naphthyl acetate esterase at an acid pH (ANAE) was investigated in 10 cases of hairy cell leukemia. All 10 cases, including two cases with only a few tartrate-resistant acid phosphatase-reactive cells, revealed a moderate or strong ANAE reaction. There was a characteristic pattern of activity consisting of small, medium-size, or large distinct granules often distributed in a semicircle in the cytoplasm, but sparing the nucleus of hairy cells. This reaction pattern was not found in T cells, T cell-derived leukemias, normal B cells, a number of B-cell lymphomas, myeloid cells, myeloid leukemias (including monocyte-derived leukemias), reticulum cell sarcoma, or malignant reticulosis. The cells from some B-cell lymphomas and plasmacytoma showed a relatively homogeneous pattern of fine or moderately coarse ANAE-positive granules that was similar to that of hairy cells only in some cases of plasmacytoma. Thus, fine to coarse granular ANAE reactivity is characteristic of hairy cells and is of potential diagnostic value for hairy cell leukemia.
A study of a unique case of unilateral digital clubbing secondary to a true posttmaumatic aneurysm of the ulnar artery in the palm is presented. The clubbing of the digits resolved following resection of the aneurysm. Detailed evaluation of the patient included Doppler flow studies, differential pulse pressure recordings, measurement of reactive hyperemia, angiography, and differential capillary blood gas determinations. The contralateral hand of this otherwise healthy young patient was employed as a control. Findings of increased blood flow, decreased peripheral resistance, and increased oxygenation then were evaluated in light of the findings of other investigators. This study and the information gathered from an extensive review of the literature strongly suggest that a neurocirculatory reflex is the common denominator of the various conditions associated with clubbing. The afferent and efferent limbs of this reflex are proposed.
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A Choyce intraocular lens was inserted nine years after a routine intracapsular lens extraction. A year after this second operation, an acute pupil block glaucoma developed. Three weeks after the onset of the glaucoma, repeated laser iridotomies controlled the glaucoma. Pupil block glaucoma may be a complication long after intraocular lens implantation.
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During the period August 1977 to April 1978, 14 Black patients in Johannesburg area had systemic infections caused by Listeria monocytogenes. Nine of these patients were neonates who presented with septicaemia (5 cases) or septicaemia and meningitis (4 cases) and 5 were adults, all of whom had meningitis. The mortality rate was 43% (6/14), with 4 neonatal and 2 adult deaths. All isolates of L. monocytogenes were type 4b. Only sporadic cases of human listeriosis have previously been reported in South Africa, and the cases reported here constitute the first epidemic in this country.
Sixteen cases of group B streptococcal (GBS) infections in neonates and infants aged up to 3 months were detected from November 1973 to January 1977. Three patients presented with pneumonia, 10 with meningitis and 3 with both pneumonia and meningitis. All diagnoses were confirmed by positive blood and/or cerebrospinal fluid cultures. The serotypes involved were type Ia (2 cases), type II (4 cases) and type III (10 cases). Ten patients died (62.5%). Early antibiotic treatment did not appear to affect the outcome, but low peripheral leucocyte count indicated a uniformly fatal outcome in 6 cases where leucopenia was documented, and this appeared to be associated with late-onset disease. The current status of GBS disease is presented, with particular reference to the control measures at present available and the possibility of immunotherapy and vaccination.
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Combined application of morphologic, immunochemical, and immunologic methods has led to a reinterpretation of non-Hodgkin's lymphomas and to the establishment of the Kiel classification. In the present paper, the main Ig-producing entities are considered. These are: 1. Chronic lymphocytic leukemia of the B-type (B-CLL)--a proliferation of lymphocytes and a few so-called prolymphocytes and lymphoblasts. The mean tissue IgM value is slightly increased; the serum IgM level is normal or reduced. The tumor cells bear SIg, and a majority of them have a receptor for C3d but always lack CIg and are usually devoid of receptors for C3b. 2. Lymphoplasmacytoid immunocytoma--a mixed proliferation of lymphocytes and centrocytes, blast cells, plasma cells, or plasmacytoid cells. The tissue Ig content is most often (91%) and most highly increased in this group, whereas the serum Ig level is increased in only 20% of the cases. The tissue IgM of 17 cases was shown to be monoclonal by IEF. Most tumor cells have SIg and a variable numbear CIg. The tumor cells bear both complement receptor subtypes, only a receptor for C3b, or no complement receptors at all. 3. Centroblastic/centrocytic lymphoma--usually a follicular proliferation of abundant small germinal center cells (centrocytes) and some large germinal center cells (centroblasts). The tumor cells bear SIg and both complement receptor subtypes. The C3b- and C3d-positive cells are located in the follicles, as in nonneoplastic lymphatic tissue. 4. Centrocytic lymphoma--a purebred, diffuse proliferation of the small germinal center cells (centrocytes). These cells bear SIg and receptors for C3b and C3d but usually lack CIg. 5. Centroblastic lymphoma--a proliferation of the large germinal center cells (centroblasts). 6. Lymphoblastic lymphoma of Burkitt's type. 7. Immunoblastic lymphoma--a diffuse proliferation of large basophillic cells resembling immunoblasts. The tissue IgM content is increased in 60% of the cases. It proved to be monoclonal with IEF in all five cases studied. The cells of five cases with increased tissue Ig content bore SIg. Nearly half of the cases studied showed CIg. Besides non-Hodgkin's lymphomas, paraffin sections of 87 biopsies from Hodgkin's disease were investigated for CIg in Hodgkin's and Sternberg-Reed cells. These cells stained positively in 68 cases, most often for IgG, followed by IgD. In five cases of the lymphocyte-depleted type, the staining of the Hodgkin's and Sternberg-Reed cells was restricted to one light chain type.
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To substantiate the origin of follicular (nodular) lymphoma cells from germinal-centre cells, the lymphoma cells from 7 patients with follicular lymphoma and from 9 tonsils and 2 lymph nodes were studied for the presence and distribution of complement-receptor subtypes (i.e., the receptors for C3b and C3d). It was found that erythrocytes coated with antibodies and C3d (EAC3d) adhered exclusively to germinal centres, whereas erythrocytes coated with antibodies and C3b (EAC3b) adhered to germinal centres and in many instances to the regions between them. These findings indicate that germinal-centre cells bear both complement-receptor subtypes and that the B cells of the interfollicular area, which belong at least in part to the precursors of plasma cells, bear only a receptor for C3b. In frozen sections of follicular lymphomas, a similar distribution of complement-receptor subtypes was observed; EAC3d was bound exclusively to the neoplastic nodules, and EAC3b adhered to the neoplastic nodules and adjacent paranodular tissue. Receptor studies on suspended cells of both normal tonsils and follicular lymphomas revealed a slight predominance of EAC3d(+) cells or equal numbers of EAC3b(+) and EAC3d(+) cells. The complete congruence in the expression and distribution of complement-receptor subtypes between tissues from follicular lymphomas and those from normal and hyperplastic tonsils or lymph nodes suggests that follicular lymphoma represents the neoplastic counterpart of the reactive germinal centre.
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Several years ago neonatal necrotizing enterocolitis (NNE) was commonly seen in an open ward for premature babies at Baragwanath Hospital, which was affected by recurrent outbreaks of gastro-enteritis and Salmonella infections. Since outbreaks of infection have been prevented, NNE has been uncommon, in spite of a high incidence of babies of low birth weight, many of who experience neonatal shock from anoxia and hypothermia, conditions considered as predisposing to NNE. The animal experimental work on the protective function of breast milk against NNE is discussed, and it is suggested that the low incidence of NNE at this hospital is due to the establishment of breast milk banks and the encouragement of breast feeding for all neonates.