Near haploid acute lymphoblastic leukemia: seven new cases and a review of the literature.

Seven new cases are described of near haploid acute lymphoblastic leukemia (ALL) and the findings reviewed together with updated complete remission duration and survival data for the 21 cases already published. The patients were four males and three females, with an age range 2-19 years; all had an immunophenotype consistent with common ALL. The poor prognostic outlook for patients with near haploid ALL is confirmed by the median remission duration of 14 months for these patients, which is comparable to that for the previously published cases. The pattern of chromosome loss was marked particularly by the presence of two copies of chromosomes 10, 14, 18, 21 and both sex chromosomes. Populations of hyperdiploid cells with double the near haploid number were observed in six of the patients, one of whom demonstrated further clonal evolution, and it is proposed that some cases classified as hyperdiploid ALL with greater than 50 chromosomes may also have arisen from a near haploid stem line.

Nutritional stability of various naturally occurring monoglutamate derivatives of folic acid.

The nutritional stabilities of four major dietary folates were studied as their corresponding monoglutamates and were compared to pteroylglutamate (folic acid) itself. The study of the monoglutamyl rather than polyglutamyl forms was justified since the former are formed during the course of digestion and also addition of extra glutamyl residues is unlikely to affect the types of nutritional instability associated with these derivatives. Since ability to support growth in Lactobacillus casei is known to reflect nutritional activity in man this organism was used in the stability studies. It was found that pteroylglutamate and 5-formyltetrahydropteroylglutamate had nutritional stabilities of the order of weeks although the stability of the former was decreased by phosphate. Surprisingly 10-formyltetrahydropteroylglutamate was nutritionally more stable than expected, possibly due to its conversion to the more stable oxidized 10-formylpteroylglutamate or to the reduced 5-formyl derivative. In contrast 5-methyltetrahydropteroylglutamate was much less stable nutritionally than expected.Unsubstituted tetrahydropteroylglutamate was most unstable nutritionally but in contrast to the other derivatives examined it was more stable under acidic than basic conditions. Ascorbate was found to be a far superior stabilizing agent than 2-mercaptoethanol at comparable concentrations.

Myeloid antigen expression on common acute lymphatic leukaemia blasts after culture.

Blast cells from seven out of ten patients with common acute lymphoblastic leukaemia (cALL) developed the myeloid antigen MY7 (CD13) after culture, and one of these coexpressed the myeloid antigen MY9 (CD33). CD13 expression appeared to be independent of maturation since it could be induced more readily in cultures which did not contain the differentiation promoter 12-O-tetradecanoyl-phorbol 13 acetate (TPA). CD13 expression in culture was not seen on one null ALL, or 6 B-CLL investigated or on normal tonsillar B cells or PBMC under similar conditions. CD13 expression on cALL blasts probably represents evidence of abnormal gene expression in the leukaemic cells. However the absence of CD13 expression on the earlier B null ALL or the later B-CLL suggests we cannot exclude the possibility that CD13 expression is a feature of normal precursor B cells.

Effect of ascorbic acid on the serum folic acid estimation.

Ascorbic acid added to the basal medium increased the growth response of Lactobacillus casei in folic acid standards. The effect in the serum extracts was not marked, resulting in lowered serum folic acid estimations. However, results obtained on prolonged incubation were similar whether ascorbic acid was added or not. The presence or absence of ascorbic acid and variation of the incubation period may account for differences in reported normal ranges of serum folic acid levels.

Congenital dyserythropoietic anaemia type II (HEMPAS): a family study.

A family having two affected siblings with congenital dyserythropoietic anaemia type II (HEMPAS) is described. The proband was diagnosed after referral for investigation of haemolytic anaemia. Clinical evaluation and in vivo red cell (RBC) survival and the sequestration studies in the proband indicated that the anaemia was due to a combination of ineffective erythropoiesis and premature destruction of RBCs in the spleen. Scanning electron microscopic examination of peripheral RBCs was undertaken and is reported. The polypeptide composition of RBC membranes was also examined using polyacrylamide gel electrophoresis after solubilisation in sodium dodecyl sulphate. These results are also reported.

An explanation of the decreased serum folate values found using methods that involve prior extraction of the serum.

IT had previously been reported that the newly introduced use of a chloramphenicol-resistant strain ofLactobacillus casei for microbiological assay of serum folate gives results approximately 20 per cent higher than the conventional method. It has now been shown that in these conventional techniques the prior extraction of the sera by autoclaving results in loss of the vitamin accounting for this decrease.

Bone marrow transplantation in aplastic anaemia.

This report describes a case of aplastic anaemia who underwent bone marrow transplantation from an ABO compatible HL-A identical sibling of opposite sex. Engraftment was observed with transient recovery of haematopoietic function and documentation of donor type sex chromosome patterns in the recipient's marrow cells. The patient died 35 days posttransplant. The transplantation protocol used and the potential for marrow allografts in bone marrow failure are discussed.

Cryptococcal meningitis occurring in HIV infected individuals.

Three cases of cryptococcal meningitis in patients with HIV infection are described. A high index of suspicion is required for diagnosis. India ink preparation and culture of the CSF for cryptococcus is mandatory in HIV seropositive patients irrespective of the CSF white cell count and biochemistry.

The emerging AIDS epidemic in Ireland--clinicopathological findings in 23 early cases.

A longitudinal study with follow up to the end of 1989 was carried out on 23 patients with AIDS who had attended St. James's Hospital, Dublin, by the end of 1987. Until then only 33 cases of AIDS had been reported in Ireland. The patients, all of whom had antibodies to human immunodeficiency virus (HIV), were predominantly male, young (mean age 31.3 years) and belonged about equally to three major risk groups: homosexuals, intravenous drug abusers (IVDA) and haemophiliacs. AIDS was diagnosed because of oesophageal candidiasis (8 cases), Kaposi's sarcoma (4), mycobacterial infection (4), pneumocystis carinii pneumonia (3), toxoplasmosis (2) or encephalopathy (2). Malignant lymphoma and a variety of infections occurred in the course of illness, and neurological involvement developed in 11 patients (48%). Mortality following diagnosis of AIDS was 39% at one year and 64% after two years. Autopsy in 10 of the 16 deaths contributed much to defining the extent and nature of the disease. The demographic pattern, risk group status, survival and range of complications were broadly similar to the pattern of AIDS as seen elsewhere in developed countries. However, compared to the profile of disease reported from the United States, oesophageal candidiasis (52%) and Mycobacterium tuberculosis (22%) were more prominent, pneumocystis carinii pneumonia (39%), Kaposi's sarcoma (22%) and Mycobacterium avium intracellulare (13%) were less frequent and cryptococcal infection was not identified. These regional variations in the frequency of the various complications and particularly the prominence of tuberculosis, probably reflect the interaction of the immunocompromised patient with the local environment and may have important diagnostic and therapeutic implications.