Liver and spleen candidiasis: imaging and verification by fine-needle aspiration biopsy.
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Biomedical subjects
Publications and source records attributed to T Ruutu.
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13 patients with the 5q- chromosome are described. In 6 patients the 5q- chromosome was the sole aberration. 10 patients had preleukaemia, 1 a preleukaemia-like syndrome after treatment of polycythaemia vera, a 2 acute myeloid leukaemia. The prognosis was especially poor in terms of survival in preleukaemic patients with 3 or more affected chromosomes: none of these 6 patients survived for more than 6 months. In 4 patients the haematological picture resembled 'the 5q- syndrome'. In the long arm of chromosome No 5 deletions of 3 different kinds were detected. They were named according to the size of the 5q- marker: the short type (10 patients), the intermediate type (1 patient) and the long type (2 patients). There was no clear correlation between the clinical picture and the type of deletion. While the break points cannot always be exactly defined, our data and those reviewed from the literature suggest that the loss of a segment of regions 5q2 or 5q3 is common to all or most deletions.
The migration in vitro of neutrophils from six patients with monosomy-7 or partial deletion of the long arm of chromosome 7 was studied by two methods: the Millipore filter assay and the migration under agarose assay. Four of the patients had preleukemia, one had subacute myelomonocytic leukemia, and one polycythemia vera. In four patients, chemotaxis (migration towards a higher concentration of chemoattractant) and chemokinesis (stimulated migration without a gradient) were shown to be defective by both methods. In the remaining two patients, this defect could be demonstrated only by the Millipore filter assay or by the agarose assay. Under agarose, random locomotion (no chemoattractant present) of the patients' neutrophils was less than that of the control subjects in four patients, whereas no clear difference could be shown by the Millipore filter method. This study demonstrates that the previously described defect of neutrophil migration in monosomy-7 involves not only chemotaxis but all stimulated migration and, at least in some patients, random locomotion as well. Defective migration in two patients with an apparently terminal deletion of the long arm of one chromosome 7 indicates that the distal half of 7q carries genetic material important for neutrophil locomotion.
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We have stored at -196 degrees C peripheral blood buffy coat (BC) and bone marrow (BM) cells collected from 47 patients with chronic granulocytic leukaemia in the chronic phase. Dimethyl sulphoxide (DMSO) 10% was used as cryoprotective agent. As these cells include CFUc and probably pluripotential stem cells they may be transfused as part of the management of patients who enter blast cell transformation. The mean numbers of nucleated cells collected and stored per procedure was about 9 times greater for BC collections than for BM harvests (106 +/- 49 (SD) X 10(9) versus 11.9 +/- 6.6 X 10(9) respectively). Agar CFUc assay showed that stored cells may remain viable for up to 5 years. Since in vitro studies showed that CFUc proliferation is not inhibited by low concentrations of DMSO the removal of all DMSO during cell reconstitution before transfusion may not be necessary. If autologous BC cells are capable of repopulating the BM of patients treated for CGL in blast cell transformation the routine collection and storage of BC rather than BM cells may be desirable for all newly diagnosed patients.
Granulocyte-committed progenitor cells (colony-forming units, CFUc) in the blood of 10 patients with primary myelosclerosis and 2 patients with myelosclerosis following polycythaemia vera were assayed by the agar culture technique. The mean number of CFUc was 54.1 +/- 109 (SD) (range 1.4--394) x 10(6)/1 which corresponded to an increase of more than 1000-fold above normal levels. There was a linear relationship of CFUc with total leucocyte count in the different patients. The magnitude of this increase resembles that found in untreated patients with chronic granulocytic leukaemia and is therefore in keeping with the concept that the concentration of CFUc in the circulation is due to a primary increase in their number and not to disordered release from the marrow.
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The function of blood neutrophil granulocytes was studied in vitro in 17 patients with preleukaemia. 3 patients had a cellular defect of chemotaxis. 2 of them had monosomy-7 in bone marrow karyotype, in 1 associated with the deletion of the long arm of a chromosome 20. The third patient had trisomy-8. In the patient with trisomy-8, the high percentage of band neutrophils was possibly associated with the chemotactic defect. In another patient with trisomy-8 chemotaxis was normal. There was a statisically significant tendency to reduced phagocytosis and impaired ability to kill Staphylococcus aureus. 1 patient with a chemotactic defect and monosomy-7 suffered from repeated infections. The other 2 patients with defective chemotaxis had several febrile episodes most probably of infectious origin, and 1 of them died in sepsis. All of these 3 patients had cutaneous abscesses. It is concluded that defects in neutrophil granulocyte function are not uncommon in preleukaemia and may result in reduced resistance to infection.
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In a study of neutrophil functions in haematological disorders using in vitro techniques, a heat-stable inhibitor of chemotaxis and phagocytosis was demonstrated in the plasma and serum of a 64-year-old woman with reticulum cell sarcoma. In partial purification by chromatography, the inhibitor activity could not be separated from IgG. Clinically the patient did not exhibit abnormal susceptibility to infections.
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