[Cryptococcus neoformans infection. Illustrated by a case of meningitis].
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Biomedical subjects
Publications and source records attributed to P Stavem.
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A patient with primary sideroblastic anaemia was observed for more than 10 years with 50% ring sideroblasts in the bone marrow and a Hb of 84-109 g/l. Iron deficiency then developed with loss of stainable iron in marrow particles (reticuloendothelial iron) and loss of all ring sideroblasts. When iron tablets had brought the iron stores in the bone marrow up to subnormal levels, the Hb was over 110 g/l, somewhat higher than it had been when the iron stores were increased. The ring sideroblasts were again raised to more than 50%.
A 62-year-old Norwegian male was found to have a leucocytosis (20 X 10(9)/l blood). About 80% of the leucocytes were T-lymphocytes with markedly convoluted, often cerebriforme nuclei. There were generalized pea-sized lymph nodes. The liver was enlarged and was found to be infiltrated with the same type of lymphocytes as were found in the blood. A bone marrow biopsy showed massive infiltration with the same kind of cells. The patient had a non-specific rash, but no generalized exfoliative dermatitis. A double set of markers was found on the T-lymphocytes, with a membrane phenotype T4+ and T8+ on practically all cells.
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A 17-year-old woman had acute myeloid leukaemia (AML) with a leucocyte count of about 100 x 10(9)/1. The great majority of the leucocytes were immature. About half of them were without granules; in the other half the granules were usually scanty, but occasionally numerous and rather coarse. A few cells had Auer rods arranged in bundles. The patient had uncompensated disseminated intravascular coagulation (DIC) with a severe tendency to bleed. Everything fitted with variant hypergranular promyelocytic leukaemia, except for the staining of 30% of the immature cells by Löffler's unspecific esterase with alpha-naphthyl acetate. The patient may, therefore, be classified as either a variant of variant form M3, or as a transition between M3 and acute monocytic leukaemia.
2 patients with multiple myeloma had the same type of crystals in plasma cells, B-lymphocytes, and T-lymphocytes. It is hypothesized that these crystals are formed in cells belonging to the same clone of pathological cells. The clone would then have to be derived from a common lymphocyte stem cell.
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Amyloid deposits aspirated from the bone marrow have a characteristic appearance in May--Grünwald-Giemsa-stained smears, and almost specific fibrillar pattern when viewed in an electron microscope.
A patient with IgG myeloma showed a highly abnormal pattern of the rough endoplasmic reticulum (RER) with multiple concentric lamellar bodies and "single sac loops". This abnormal pattern might be due to either a complete rearrangement of the architecture within the cell, and/or a pathology in the wall of the sacs of RER.
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During transmission electron microscopy of plasma cells from two patients with plasma cell proliferative disorders, we observed a large number of small crystals, most of which showed a striation with alternating light and dark parallel lines. Ultraphotos strongly suggested that smaller crystals often coalesced to larger ones. The coalescence occurred in such a way that the parallel lines of the respective smaller crystals always met each other end-to-end and hardly ever end-to-side. A similar pattern can be seen on previously published ultraphotos from other patients with plasma cell proliferative disorders and intracellular crystals, although not commented upon by the respective authors. The parallel lines of the smaller crystals certainly must correspond to defined structures of the crystal. The stability of a certain configuration is therefore in all likelihood due to electrical potentials created by the crystal structure.