[Possibilities and limitations of computerized tomography in the staging of the subdiaphragmatic spread of Hodgkin's disease]. / Möglichkeiten und Grenzen der Computertomographie im Staging der subdiaphragmalen Ausbreitung des M. Hodgkin.

The value of computed tomography in the assessment of subdiaphragmatic spread was studied prospectively in 72 patients with so far untreated, histologically confirmed Hodgkin's disease. In 17 patients (23.6%) computed tomography (CT) diagnosed subdiaphragmatic involvement, with no false-positive results. In 55 (76.4%) CT was within normal limits. In 30 patients exploratory laparotomy gave false-negative results in 7 (23.4%). The causes of false-negative results in CT are that lymph-nodes which were not enlarged but involved were not demonstrated and spleen involvement was not identified. Including those correctly positively diagnosed cases (17), CT had a sensitivity of 70.8% and a false-negative rate of 29.2%. It is concluded that when CT is within normal limits only exploratory laparotomy can with certainty exclude subdiaphragmatic involvement.

Conversion of an IGM secreting immunocytoma in a high grade malignant lymphoma of immunoblastic type.

A case involving a 67 year old man with an immunocytoma initially presenting as Waldenström's macroglobulinemia which transformed into a high grade malignant lymphoma of immunoblastic type after treatment with cyclophosphamide and corticosteroids over 5 months is presented. IgM (kappa) present in the serum in the phase of immunocytoma was demonstrated also on the less differentiated cells of the high grade lymphoma. The permanent production of the same immunoglobulin molecule suggests that both morphologically different malignancies derived from one B cell clone.

[Chronic septic granulomatosis imitating exogenic allergic alveolitis (farmer's lung)]. / Das vorgetäuschte Bild einer exogenen allergischen Alveolitis (Farmerlunge) bei chronischer septischer Granulomatose.

A 17-year-old boy demonstrated clinical and immunological signs of exogenic allergic alveolitis (farmer's lung). The patient grew up in the country and suffered from recurrent "pneumonia." In his serum precipitins were detected against Micropolyspora faeni, Aspergillus fumigatus and hay. Transbronchially obtained lung tissue showed histologically an inflammation of the epitheloid-cell-granulomatous type with fibrosis. A congenital defect of the neutrophilic function was suspected in view of the recurrent infections with significant polyclonal hypergammaglobulinemia, accompanied by leucocytosis and neutrophilia. In vitro studies of isolated patient's neutrophils showed that he suffered from chronic granulomatous disease. CGD should be considered in adolescents and adults with a history of severe infections and unexplained pulmonary fibrosis or pulmonary fibrosis simulating exogen allergic alveolitis.

[Clinical significance of cationic proteins of leukocyte lysosomes: cationic leukocyte antigen (CLA) as a marker of blast crisis in chronic myelocytic leukaemia (author's transl)]. / Klinische Wertigkeit von kationischen lysosomalen Leukozytenproteinen: Bedeutung der immunologischen Bestimmung von Kationischem Leukozytenantigen (CLA) für die Diagnose der Blastenkrise bei chronischer Myelose.

Cationic leukocyte antigen (CLA) was estimated in urine of acute and chronic leukaemics using quantitative immuno-precipitation techniques. The studies demonstrated that CLA is a marker of the (myelo-) blast crisis in patients with chronic myelocytic leukaemia (CML). By these studies the value of the determination of CLA for the differential diagnosis of acute myeloblastic leukaemia versus initial (myelo-) blast crisis in CML and the lymphatic leukaemias, respectively, was evident. The terminal blastic transformation in CML was indicated early by an elevation of the urinary CLA-level. The blast-crisis was accompanied by a heavy CLA-uria. The results are documented by demonstration of special studies of characteristic cases and discussed in the light of recent results of immunological and cytochemical findings on the nature of blast crisis in CML.