Radioactive lymphography (endolymphatic radiotherapy) in Hodgkin's disease. Statistical study of 373 cases.
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Biomedical subjects
Publications and source records attributed to L Revol.
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Hairy cells obtained from nine patients with hairy cell leukaemia were found to be sensitive to a heterologous anti-human B lymphocyte serum using a cytotoxicity assay and the ultrastructural characterization after immunoperoxydase labelling. This antiserum raised in the rabbit and rendered specific by extensive absorptions with human immunoglobulins, erythrocytes, thymocytes and monocytes, reacted with normal and pathological B lymphocytes but not with monocytes, as demonstrated by ultrastructural studies. In addition, a heterologous anti-hairy cell serum was prepared and absorbed with erythrocytes, thymocytes and monocytes. The in vitro properties of this antiserum were identical to those of the anti-human B cell serum in the various assays: cytotoxicity, rosette inhibition and ultrastructural characterization. These results demonstrate that hairy cells of the studied patients express surface antigenic specificities of the B cell population, not shared by monocytes. Further absorption of the anti-hairy cell serum with CLL cells suggested that hairy cells express other characteristic antigens in addition to the B lymphocyte antigens. HLA-DR alloantigens were also shown to be present at the surface of hairy cells. This type of immunological analysis may prove to be of help in the understanding of the differentiation abnormalities in the hairy cell leukaemia as well as in other lymphoproliferative disorders.
The results of 373 lymphography examinations with radioactive lipiodol, conducted in 408 patients with Hodgkin's disease for diagnostic and prophylactic therapeutic purposes, during investigations carried out from 1966 to 1973 are analyzed. Tolerance was always excellent, especially from the hematological point of view. The efficacy of the procedure can be assessed by the fact that there were only 6% of failures (21/373) in glandular regions irradiated in this way for prophylactic purposes. Relapses occur more frequently in the inguino-iliac and lumbo-aortic regions than in the pelvic chains which were perfectly protected. This technique also enables both pelvic irradiation and ovarian protection in young women without any risk of failure. The procedure is particularly indicated in the following cases: supradiaphragmatic stages I and II, whatever the sex, and stage III especially in women. In sub-diaphragmatic stages I and II, it allows, in favourable cases, the ovarian function in women to remain intact by limiting external irradiation to invaded regions only.
16 our of 370 acute myeloid leukemias treated between 1964 and 1973 have been in long survival for more than three years. In the first period 1964-1971 the overall remission rate was 20% and 6 patients has a long survival. In the last two years of study, 10 out of 96 patients have more than three years of survival, the remission rate was over 50%. All the cases were slightly proliferative the first group did not recieve intensive chemotherapy and appear as spontaneous long remission, but in thelast patients intensive chemotherapy seems responsible for the good results.
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The survival of patients with acute non-lymphoid leukaemias (ANLL) receiving chemotherapy (32 patients) or chemotherapy plus BCG (31 patients) has been compared in a randomized trial which started in Nov 1974. Fresh BCG (Institut Pasteur, Paris) was administered by Heaf gun in the interval of chemotherapy cycles. The overall survival was better in the chemo-immunotherapy group (median duration of survival of 25 months compared to 16 months in the chemotherapy group). However, the first remission duration did not differ (median duration of the 15 and 12 months, respectively). Plateau survival curves were not obtained in either group. A second complete remission was obtained in 7 out of 12 patients with bone marrow relapses in the chemo-immunotherapy group, and only in 2 out of 15 in the chemotherapy group (P less than 0.05). BCG seemed more efficient in patients older than 40 years; no difference was observed according to sex.
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A study of granulocyte functions in acute myeloblastic leukemia is reported. Functions were assessed by the ability of polymorphonuclear to migrate in Boyden's chamber, to ingest and kill staphylococcus aureus. Chemotaxis was grossly impaired. Cellular imparirment of phagocytosis and bactericidal capacity was observed in 5 and 9 patients. An inhibitor of phagocytosis and bactericidal capacity was observed in 9 and 4 patients. Results improved in complete remission.
Since November 1974, 44 patients with acute myeloid leukemia, in first remission were randomized between chemotherapy alone and chemotherapy plus BCG. There were 8 relapses and 7 deaths with chemotherapy, 7 relapses and 3 deaths with chemotherapy plus BCG. The survival of both groups is not, at the time, significantly different.
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A case of Waardenburg-Klein syndrome associated with a Hodgkin's disease is reported in a 29 year old female. Such an association seems to be fortuitous. The authors discuss the dermatological aspects of this rare disease, particularly the disturbances of cutaneous pigmentation. Ultrastructural study of depigmented skin indicates the melanocytes are absent and precise the place of this depigmentation in the group of genetic abnormalities of skin pigmentation.
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The authors report two cases, the first pathological and the second clinical of pseudo-tumoural cerebral toxoplasmosis, occurring during the course of blood diseases. They refer to the conditions of appearance of this rare complication, with only twenty cases recorded in the literature, during malignant blood diseases. They stress the primordial role of immunological deficiency related either to the underlying disease (especially Hodgkin's disease) or to immuno-suppressive therapy. The clinical picture, with little in the way of typical features, is thus that of a diffuse méningo-encéphalitis. Pseudo-tumoural forms are rare. The authors also stress the minimum conditions required for the validity of the dye test and the value of the diagnosis of cerebral toxoplasmosis. An association of sulphadiazine-purimethamine, active and effective, cured the second patient.
Short treatment with four cytostatics in acute granulocytic leukemia induced aplasia and reduction of total leukemic cells in 50 over 59 patients. Complete remission occured in 30 and 20 died with infectious complications during induction. Short induction treatment allowed a reduction of induction period and so a reduction of high risk period of induction before completion of complete remission.
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The authors emphasize the relative frequency of neurological symptoms in lymphatic leukaemia. Clinically, these cause more or less diffuse encephalitic or multineuritic syndromes, generally a combination of the two. Their pathogenesis is usually connected with lymphoid tissue infiltration into either the meninges or the vascular sheaths of the central nervous system or the sheaths of the roots or of the peripheral nerves. The authors stress the possible function of immunoglobulin abnormalities of the C.S.F. indicative of the presence of the leukaemic process within the nervous system. This pathogenesis prompts the use of therapeutic methods directly attacking leukaemic infiltration of the nervous system (focal cobalt therapy, intrathecal chemotherapy) and the authors have found that these give favourable results.
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