[Intravascular coagulation, thrombopenia, intracerebral hematoma attributable to heparin therapy].
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Biomedical subjects
Publications and source records attributed to M Leporrier.
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A case of displacement of remaining left kidney across the midline because of a big splenic enlargement due to chronic lymphoid leukemia is reported. As observed in the rare cases of the literature, this observation illustrates that the kidney returns to a normal position after disappearance of the splenomegaly, in this case after chemotherapy followed later by splenectomy.
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A Coulter ZB was used to measure electronically the size of circulating platelets collected from normal subjects. EDTA or ACD were used for collection. Three mathematical models of volume histograms were tested. The lognormal law model is clearly unacceptable if all particles are used, but is applicable in the particle range of 3-15 mu 3. The model of a mixture of two lognormal populations closely approximates observed volume distribution. The model of three lognormal populations also approximates well when the largest volume population is divided into two subpopulations. The contribution of these results to an understanding of heterogeneity in platelet size is discussed.
The use of immunocytochemical techniques enables one to quantify antibodies bound to cell membranes. We have tested the platelets of subjects with immune thrombocytopenic purpura by this method. The washed platelets were incubated in the presence of antiglobulin conjugated with an equimolar amount of peroxidase. The fixed peroxidase was revealed and quantified by an enzymatic reaction using orthodianizidine-H2O2. From the results the number of immunoglobulin molecules per platelet was calculated. The test was calibrated so as to eliminate non-specific fixation of the reagent. Under these conditions the platelets of subjects with idiopathic thrombocytopenic purpura bound a much large amount of detectable immunoglobulin (800-21 000 molecules per platelet) than those of normal subjects (235 +/- 74 sites per platelet) or subjects with non-immune thrombocytopenia (395 +/- 203 molecules per platelet).
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The peripheral lymphocyte count was investigated prior to and 4 h after a single intravenous injection of 400 mg of hydrocortisone (HSHC) in 23 controls and 43 patients with chronic lymphocytic leukemia. A reduction in the peripheral lymphocyte count was observed in all normal controls, the mean decrease being 51.9%, with differences according to age.
The munber of large peripheral lymphoid cells and the ratio of these large unstained cells (LUC) to the total number of peripheral lymphocytes were determined by means of the Hemalog D in 57 patients with chronic lymphocytic leukemia (CLL) and in 100 controls. While the absolute number of LUC per mm3 is simply a reflection of peripheral lymphocytosis, the ratio LUC/total lymphocyte count was shown to correlate with clinical staging. In controls, this ratio ranged from 3.2% to 11.2%. In CLL is was less than 11.2% in 43 patients and less than 11.2% in 14 patients. This latter group corresponded statistically to patients with advanced disease in our clinical staging system (stages III and IV). An increase in the LUC/total lymphocyte ratio is therefore a statistical criterion of poor prognosis.
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A new case of cold agglutinin disease in a patient who had a long lasting Raynaud's phenomenon without hemolysis and a persistent HB antigen cirrhosis, is reported. The cold agglutinin is a monoclonal IgA kappa antibody which reacts at 4degreesC to a titer of 256. As the three other cases described in the literature, it demonstrates Pr1 specificity. The eluate from human cells reacts with rat and dog cells whose receptor is destroyed by both papain and neuraminidase, thus eliciting the characteristic Pr1d specificity.
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Three cases of light chain deposition disease are reported. The condition was associated with monoclonal dysglobulinaemia in two cases and with amyloidosis in one case. This, and the different course of the disease in these three patients, illustrates the need for an early histological diagnosis, using immunofluorescence with monospecific anti-light chain sera.
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We present two cases of primary malignant lymphoma of the liver, a very unusual localization of primary malignant lymphoma since only 31 similar cases were reported in the literature. The main symptoms included: hepatomegaly, fever, slight cholestasis and non specific alteration of the liver appearance on ultrasonography or computed tomodensitometry examination. Diagnosis was established in both cases by histopathological demonstration of infiltration by large lymphoid cells. Immunophenotyping in one case confirmed a B cell phenotype. Primary malignant lymphomas of the liver are high-grade malignant large-cell tumours and the immunophenotype, when known, is of the B type. The prognosis of these tumours is not well known due to their extreme rarity. They appear to be highly chemosensitive and cure may be obtained in the long-term in some cases. These data justify careful histological assessment in all cases of hepatomegaly of a tumoral nature.
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