Biomedical subjects
Publications and source records attributed to M Raphael.
One hundred and eighty high risk cases in a hospital special treatment centre and 50 low risk cases of vaginal discharge from general practice were investigated by the cultural examination of vaginal secretion. The results show this procedure is of value in diagnosing sexually transmitted diseases.
Twenty patients undergoing routine left ventricular single-plane angiography have been investigated by an ultrasonic triggered B-scan technique to provide a two-dimensional cross-sectional image of the left ventricle in end-systole end-diastole. An area-length method has been used to establish the correlation between the angiographic and the echocardiographic assessments of left ventricular chamber volume (r equals 0.88) and ejection fraction (r equals 0.81). Differences between the two techniques are discussed, and it is concluded that in approximately 80 per cent of patients triggered B-scanning may provide a safe, non-invasive, and convenient technique for the determination of volumes and certain functional parameters, especially in patients with dilated hearts and irregular left ventricular shape, where M-scanning is known to be less reliable.
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We report the case of a 68-year old woman complaining of disorders of memory and persistent headaches in whom the diagnosis of Waldenström's macroglobulinaemia (WM) was made. Computerized tomography of the brain showed a butterfly-shaped hyperdensity in the splenium of the corpus callosum, with ventricular dilatation. Magnetic resonance imaging displayed high-intensity signals on T2-weighted sequences. Protein immunoelectrophoresis elicited an IgM kappa peak. The CSF was found to contain proteins and lymphocytes in excess, and immunohistochemical staining confirmed the predominance of anti-kappa and the presence of intrathecal IgM secretion. Chemotherapy was temporarily effective on the memory disorders, but the patient died 26 months after the beginning of treatment. Central nervous system manifestations are seldom observed in WM, and they are now grouped under the name of Bing-Neel syndrome. Psychic disorders are rarely reported. It is suggested that IgM secretion plays a predominant role in the pathogenesis of leucoencephalitis, and this is supported by the finding of intrathecal IgM synthesis.
A 57 year old man was referred to us with multiple long-standing, recurring and refractory mouth ulcers involving the palate, the intermaxillary folds, the inner side of the cheeks, the frenum of the tongue, a tonsil, the pharynx, the gums and a lower lip. Multiple biopsies had excluded a lymphoma, a carcinoma and infection. A new biopsy showed a polymorphous granuloma with up to 40% of atypical lymphoid cells. No angiitis was present, but an angiocentric pattern was present in the granuloma. The atypical cells stained positively with OKT3 and OKT4 antisera. The patient also had cardiac rhythm disturbances with defects on the myocardial scan and a proteinuria. Thus, we suspected the diagnosis of lymphomatoid granulomatosis, although there were no pulmonary nodules. Cyclophosphamide and prednisone were given with immediate success. As the doses were gradually decreased, a small relapse occurred. It was controlled by increasing the cyclophosphamide dosage for six months. The patient is now in complete remission more than four years after having discontinued the treatment. Thus, lymphomatoid granulomatosis can be diagnosed on the basis of a biopsy of buccal ulcers and in the absence of the classical pulmonary nodules. We found no evidence that the atypical cells were lymphomatous; rather, the very good response to the treatment points to a curable granulomatosis.
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A new case of lymphocytic interstitial pneumonitis developed in the course of a persistent generalized lymphadenopathy syndrome is reported. The patient was a 30-year old Haitian woman with only her ethnic risk factor. Broncho-alveolar lavage showed high cellularity with mostly major lymphocytosis (76%) and a fall of the OK T4/OK T8 ratio to 0.23. The LAV was isolated from the lavage fluid lymphocytes on the same day and within the same culture time as from blood, using lymphocyte culture and measurement of reverse transcriptase activity in the supernatant fluid of cell cultures. This, together with the strongly positive (1/80) LAV serology in fluid as compared with blood (1/640), suggested that the LAV virus was directly or indirectly involved in the pneumonitis, being responsible for lymphocyte proliferation as it is in lymph nodes. No superinfection with a bacterial, fungal or other than LAV viral agent was found in blood or in lavage fluid. Lymphocytic interstitial pneumonitis is uncommon in AIDS or ARC (13 cases reported), but its incidence no doubt is underestimated, as it may be latent. It certainly accounts for the high lymphocyte count observed in broncho-alveolar lavage fluid in the absence of superinfection and, most probably, for many cases of so-called "non-specific pneumonia". In 1986, patients with apparently primary lymphocytic interstitial pneumonitis should be investigated for AIDS or ARC.
Expression of the IL-13 gene in malignant tissues from 26 human B-cell lymphoid malignancies was analyzed by reverse transcriptase-polymerase chain reaction (RT-PCR). A positive signal was detected in 16 cases, which included high grade B lymphomas, follicular lymphomas and B-cell chronic lymphocytic leukemias. IL-13 mRNA was also detected in the 9 malignant B cell lines and in the 6 lymphoblastoid cell lines tested, as well as in freshly isolated malignant B cells from 2 patients with a Burkitt's lymphoma. Two of 8 T-cell lymphomas and 2 of 4 T-cell lines expressed the IL-13 gene. In contrast, IL-13 gene expression was not detected in any of the 5 non-lymphoid cell lines tested. No specific binding of radiolabeled IL-13 was detected on B cell lines, suggesting an absence of IL-13 receptors on such cells. This conclusion was also supported by the inability of IL-13 or anti-IL-13 antibodies to affect the growth of malignant B cells. Taken together, these results show that both malignant and EBV-transformed B lymphocytes, either freshly isolated or maintained as cell lines, express the IL-13 gene. This raises the question of the role of B lymphocyte-derived IL-13, a B lymphocyte stimulating cytokine, on the in vivo function of normal B lymphocytes as well as on the in vivo behaviour of B lymphoid malignancies.
Massive haemoptysis is rare but associated with a high mortality. Even in a major regional cardiothoracic centre only one or two cases will be seen annually. As a consequence, no consensus about its investigation and management has emerged, with the result that much time may be lost on inappropriate investigation and treatment may be misdirected.