Extremely long duration of chronic myeloid leukaemia with Ph1 negative and Ph1 positive bone marrow cells.

A male patient still surviving 17 years after the diagnosis of chronic myeloid leukaemic (CML) is described. A chromosome analysis of the bone marrow 16 years after the diagnosis revealed 84% Ph1 negative and 16% Ph1 positive cells, all containing the Y chromosome. The disease has been very sensitive to treatment with busulphan but bone marrow hypoplasia has not been induced. It is probable that in some CML patients with such a double cell population the prognosis may be extraordinarily good and that they run a considerable risk of being overtreated due to a pronounced sensitivity to alkylating drugs. Such rare cases should not serve as arguments for aggressive treatment of CML.

On some late effects of bilateral oophorectomy in the age range 15-30 years.

Between 1910 and 1940, 146 young females, aged 15-30 years, underwent bilateral salpingo-oophorectomy as part of a radical operation for salpingo-oophoritis. These women or their records were reviewed in 1971. 42 women had died in the meantime. More than half (22) of them had died from cardiovascular diseases, 5 from carcinoma of the uterus and 4 had committed suicide. None had died from carcinoma of the breast. Of 68 who were still alive, information by questionnaire was obtained and 32 were admitted to hospital for extensive examination. 32 age-matched women to be operated on for prolapse but with no other known disease of the reproductive tract served as controls. A further control group was added as 11 of the 68 were found to have menstruated again after the operation which had evidently not completely removed the gonads. Complete oophorectomy was found to have been followed by: (a) an increased incidence of cardiac symptoms and nervous diseases as well as an increased use of drugs; (b) a significant increase in the frequency of coronary vascular diseases in ages up to 70 years; (c) an increase in the serum cholesterol and triglycerides, most significantly in the ages below 60-65 years. Women with symptomatic coronary disease had a higher serum cholesterol level than women without and women with signs of peripheral vascular diseases had a significantly higher concentration of serum triglycerides; (d) an increased frequency of fractures (radius and femoral neck), increased osteoporosis and thinner cortical bone. The brittleness of the skeleton was correlated with low excretion of oestrogens in the urine. No vertebral compression or abnormal decrease in height was observed. (e) an increased adrenocortical activity with significantly increased excretion of 17-ketosteroids, 17-OH-ketosteroids and low polar total oestrogens. This activity abated in women above 65 years. (f) a traumatic psychological experience of the accompanying sterility while sexuality seemed to be largely unaffected in many of them. Almost half of the women examined by the psychiatrist were unusually mentally active and agile and they had a lower excretion of estriol than the rest.