[Hematological studies of the populations of Lower Silesia living in different ecological conditions]. / Wyniki badan hematologicznych populacji Dolnego Slaska zyjacych w róznych warunkach ekologicznych

Haematological investigations were carried out in different population groups in Lower Silesia. The total material investigated included 439 men and 229 women. The investigations demonstrated that the haemoglobin level, erythrocyte count haematocrit index were lower in the population of villages lying around copper processing plants. The mean reticulocyte count exceeded significantly that in the control group. The highest parameters of erythrocyte system were found in the group of men from a large city despite their occupational exposure to exhaust gases. The leucocyte count was 6-7000/mul in all groups with the exception of the urban group in which it was 1000-1500/mul lower than the mean values in the remaining groups. Lymphocytosis was observed most frequently in this group. The highest mean percent of granulocytes and the lowest incidence of lymphocytosis were observed in the control group from a rural population in a non-industrialized area while rural groups around industrial centres showed intermediate values. In the female group from a locality exposed particularly to industrial pollution low platelet count was frequent.

[Cytochemical tests on sediment cells of malignant and benign exudates]. / Zytochemische Tests in Sedimentzellen maligner und benigner Exsudate

In exsudate cells separated from serous body cavities of 29 tumour patients and 30 patients with inflammatory and congestive effusion in cardiac failure or liver cirrhosis respectively the activities of acid and alkaline phosphatase were determined. In addition to sudanophilia the cell content of glycogen and that of ribonucleinic acid were evaluated. By means of cytochemical findings it could be found that an increase of unspecific esterase, acid phosphatase and ribonucleic acid in atypical cells points to a malignous ethiology of the exudate.

Osteolytic lesion in chronic myelogenous leukaemia.

Destructive bone lesion of the femur was observed in one patient from a series of 103 patients with CML. Numerous myeloblasts were seen on touch preparations of the fresh surgical specimen obtained by open biopsy of the affected area. Bone marrow and peripheral blood differential count were compatible with chronic phase of CML at this time. 5 months later blastic crisis developed. Local radiotherapy produced effective palliation of pain but did not prevent blastic transformation of CML. The treatment of blastic crisis was unsuccessful and patient died 3 years after diagnosis of CML, 6 months after the first clinical evidence of bone infiltration.

Burns: causes and risk factors.

In a retrospective study of 277 adult patients consecutively hospitalized for burns over a five-year period (1975-1979) patients' characteristics, circumstances of burn injury and prevalence of established predisposing factors were determined. The average age was 44.5 years, 78% were black and 62% were men. Average extent of burn was 19.7% body surface area. Major causes included flames in 44.8%, scalds in 28.5%, and chemicals in 9.7%. Seventy-four percent of all burns occurred at home. Burns resulting from assault accounted for 20.9%. Fifty-six percent of the patients had one or more of the established predisposing factors. Judged to be predisposed to burn injury were all of those who attempted suicide, all who were using self-treatment for some preexisting conditions, 85% of the elderly, 83% of those who died, 81% of those burned in the bathtub and 80% of those assaulted. Other described groups were also at high risk. Living alone increased risk of injury in persons prone to burn. The most common predisposing factors were alcohol and drug abuse, physical and mental illness and advanced age. Mortality rate was 12.6%. This study emphasizes the urgent need for effective burn prevention programs in which all health professionals should play an important role.

Non-specific cross-reacting antigen (NCA) in individual maturation stages of myelocytic cell series.

The distribution and localization of NCA and carcinoembryonic antigen CEA in cells of different types of myelogenous leukaemias (acute myelogenous leukaemia - AML; chronic granulocytic leukaemia - CGL; CGL in myeloblastic crisis - CGL-BC) was studied using the immunofluorescence test. Discontinuous density-gradient centrifugation was used to separate myeloid cells into fractions containing granulocytes in individual stages of maturation. Serum NCA and CEA levels were estimated in parallel. It was established that: (a) AML blasts without maturation (MO type) and monoblasts did not synthesize NCA; (b) individual blasts of AML with features of maturation (M1, M2 types) and some myeloblasts of CGL-BC exhibited a limited ability to express cytoplasmic NCA; (c) the number of NCA-containing cells increased in the more mature granulocyte fractions isolated on Ficoll-Hypaque density-gradients; (d) myelocytic NCA is immunologically related to NCA isolated from lung tissue and (e) CEA is undetectable in the myelocytic cell series.

Clinical course and results of treatment of erythroleukaemia.

13 patients with erythroleukaemia were observed between 1971-1982. The initial laboratory findings revealed normocytic anaemia with the presence of erythroblasts up to 73% of nucleated cells. The leukocyte count was normal in 5 patients, low in 5 patients and elevated in the rest. Thrombocytopenia was present in all patients. The bone marrow showed hyperplasia of erythroid series. In the majority of cases structurally abnormal erythroblasts could be found. Myeloblasts in peripheral blood and bone marrow were found at diagnosis in 12 patients. In the terminal phase, the bone marrow showed the picture of acute granulocytic leukaemia, only in one patient of acute monoblastic leukaemia. Partial remission was obtained in 6 patients, the rest did not respond to any protocol. Survival time amounted to 2 to 30 months after diagnosis.

Immunological typing of blast cells. Cases with pre-B cell characteristics.

Leukemic cells from 32 patients were examined by using conventional immunological markers (E and EAC rosettes, surface immunoglobulins). Additionally, the test for intracytoplasmic IgM, Fc IgG receptor and the presence of light chains were performed. Leukemic blasts of all patients were investigated according to morphological and cytochemical criteria. Lymphoblasts from 3 patients had pre-B cell phenotype: cIgM +, sIg-. Each of 3 patients with pre-B cell characteristics had different diagnosis and different morphological and cytochemical features of the leukemic cells (ALL, NHL and CML). In 24 ALL cases the diagnosis of non-T, non-B ALL, in 4 cases T-ALL and in one B-ALL was established. The correlation of cytochemical results with special reference to acid phosphatase and immunological subclasses of ALL was also analyzed. An important question is raised with regard to diagnostic classification and treatment by finding ALL phenotypes in lymphoproliferative disorders that are not diagnosed as ALL.

Long-term function of persons with atherosclerotic bilateral below-knee amputation living in the inner city.

Long-term function of 24 elderly persons with atherosclerotic bilateral below-knee amputation living in an inner city for at least six months after the second amputation, was determined. Twenty-one (87.6%) subjects were living at home; three were living in nursing homes. Fourteen (70%) of 20 subjects who received bilateral prostheses were ambulators. At interview, the mean age was 75.2 years; 4.87 years was the mean time since the second amputation. Ten (50%) subjects remained ambulatory. Among the other ten who received prosthesis, loss of ambulation occurred mostly due to medical factors, at an average of 3.47 years after the second amputation. Those no longer ambulatory were older and "sicker," and the interval between amputations was shorter. Fifteen (62.5%) subjects were independent in dressing, 14 (58.4%) in toileting, and only nine (33.3%) in bathing. All but one subject required housekeeping assistance. The anticipated effect on function of environmental and socioeconomic factors could not be demonstrated in this sample. Survival time and retention of ambulatory skills for an average of nine years after the second amputation in eight (33.3%) subjects who died before the end of the study was longer than previously described. The high rate of success in rehabilitation and in maintenance of ambulatory skills fully justifies intensive restorative efforts for this group of amputees.

Bilateral below-knee amputations: experience with 80 patients.

This review expands information concerning the bilateral below-knee (BK) amputee, describing the findings of a retrospective assessment of 80 such patients. Factors evaluated included etiology, associated conditions, time between amputations, late revisions, use of prostheses, and survival. In 63 patients both amputations were because of atherosclerosis. Of these patients, 86% were diabetic and 84% hypertensive. Peak incidence of the second amputation was during the 7th decade. Average time between amputations was 23 months. Forty-five (71%) of the atherosclerotic patients achieved some functional use of bilateral prostheses. The five patients employed at the time of the second amputation returned to work using prostheses. Average survival after the second amputation was 44 months for those deceased, and 64 months for those alive at the end of the study period. Nine patients had amputations because of various forms of injury, including one for sequential developments due to alcohol-related sensory loss. Eight of this group had a diagnosis of alcohol abuse of psychosis. Reasons for amputations included frostbite, burns, suicide attempt and sensory loss. Five achieved long-term but generally suboptimal prostheses use. The findings support the impression that most atherosclerotic bilateral BK amputees can use prostheses and that their survival and low rate of late stump revisions justify restorative efforts. Mental status was the major determinant of amputation and prostheses use among the non-atherosclerotic patients; discharge from psychiatric hospitals without adequate community support systems was probably contributory. Management and prevention require close collaboration between the rehabilitation, surgical, psychosocial, and public health disciplines.