Phenotypic analysis of T-cell acute lymphoblastic leukemia in Egypt.

Leukemic cells from 46 T ALL cases were studied with a wide panel of mAb reacting with T cells using an immunoperoxidase technique. The cases included 15 adults (16 years or over) and 31 children (less than 16 years). The mAb used in the panel were: CD1, (T6), CD2 (T11, X11, D66, clone 2), CD3 (T3/Leu4), CD4, (T4/Leu3a), CD5 (Leu1, T1, A50, I73D9), CD7 (Leu9, I21), CD8 (T8/Leu2a) and HNK1. Based on their reactivity with the mAb panel all cases were assigned to one of the intrathymic differentiation compartments. Among the adults, five cases were assigned to compartment I, six to compartment II and four to compartment III. The pediatric cases included eight in compartment I, eighteen in compartment II and five in compartment III. Fifteen L1 cases studied included four in compartment I, seven in compartment II and four in compartment III; while thirty L2 cases showed nine in compartment I, sixteen in compartment II and five cases in compartment III. The most frequently observed CD groups among T ALL cells were CD5 (100% and 88.9% in children and adults respectively), CD7 (93.1% and 84.6%) and CD2 (76.7% and 76.9%). The most frequently reactive mAb in our series was Leu1 (81.8% followed by I21 (71.1%) and Leu9 (68.9%). The most frequently reactive combination of two mAb was Leu1/I21 (100%) followed by Leu1/T11 (97.4%). Five of the 46 cases reacted with HNK1, suggesting an origin from the natural killer (NK) subset. Our results indicate that in T-cell ALL in Egypt the surface phenotype is similar to that of intermediate or late thymocytes in more than 66% of cases. CD5, CD7 and CD2 were the most frequently detected antigens. Studies of the association between T-cell phenotype and socioeconomic status are warranted.

Immunological phenotypic pattern of acute lymphoblastic leukaemia in Egypt.

We have performed immunophenotyping studies on 186 untreated cases of acute lymphoblastic leukemia (ALL) in an Egyptian population, using panels of monoclonal antibodies (mAb) and an avidin-biotin-immunoperoxidase detection system. Sixty-two of these cases were tested with a panel of mAb directed against the T-cell markers CD2, CD4, CD8, B-cell markers CD20, kappa and lambda, the common ALL antigen (common ALLa) and class II HLA antigens. The remaining 124 cases were also tested with additional markers of T- and B-cell precursors, namely CD7 and CD19. The common leukocyte antigen, T200, was used to exclude nonhemopoietic neoplasms. Cases that remained unclassifiable were further tested with a wider panel of T-cell markers, including CD1, CD2, CD3 and CD5. In some cases multiple mAb directed against the same antigens were used. The relative frequencies of common ALL and B ALL were calculated from the total number of cases and were found to be 39.2% and 3.2%, respectively. The proportions of T-cell and null leukemias were calculated from the better characterized subgroup of 124 cases, and were found to be 50% and 4.8%, respectively. In our series, the age distribution of common ALL revealed a peak at 2-5 yr, but this was partially obscured in the entire series by the high proportion of T-cell cases, which had an age peak between 4 and 12 yr of age. Our results demonstrate marked differences in the phenotypic pattern of ALL in Egypt compared to Western Countries, the predominant finding being a relative excess of T-cell ALL and a paucity of common ALL cases. At present it is not clear whether this results from an increased incidence of T-cell ALL or a decreased incidence of common ALL.

Broad spectrum antifungal agents in otomycosis.

The in vitro inhibitory activities of four currently used antimycotic agents (clotrimazole, econazole, miconazole and cyclopirox-olamine) against 304 fungal isolates comprising 51 species from 14 genera of moulds and yeasts, using a serial dilution procedure, were studied. Clotrimazole and econazole were found to have a grossly similar broad-spectrum antifungal activity, inhibiting all the tested yeasts and moulds at a concentration ranging from 0.1-4 micrograms/ml. At this range miconazole inhibited 90 per cent of the strains and cyclopirox-olamine inhibited 57 per cent only and thus they were less effective. Econazole 1 per cent solution was very effective in vivo in the treatment of otomycosis within 1-3 weeks. The drug was well tolerated, with no side-effects. Owing to the high broad-spectrum antifungal activity of clotrimazole and econazole, they should be the treatment of choice in otomycosis and can be used safely as otic drops.

Early surgical treatment of cutaneous leishmaniasis.

Cutaneous leishmaniasis, treated or untreated, is known to leave disfiguring scars. These scars are usually on exposed parts, for which plastic surgery may be required. The present work deals with the treatment of cutaneous leishmaniasis using surgical techniques from the onset. In 20 patients, 35 lesions were excised down to the deep fascia. To cover the resulting defect, subcuticular sutures were used in 7 small lesions. Dufourmental (LLL flap) and Limberg flaps were used in 23 lesions of moderate size. Free grafting was resorted to in five large lesions. Using these techniques, morbidity was reduced and cosmetic results were satisfactory.

A direct lead technique for histochemical demonstration of leucocyte alkaline phosphatase activity in blood smears.

A histochemical technique for demonstrating leucocyte alkaline phosphatase activity (LAP), based on direct precipitation of lead phosphate at pH 9.5, is described. The effect of fixative, temperature and stability of the medium on the activity of the enzyme and stability of the colour reaction was thoroughly studied. Peripheral blood smears obtained from both normal humans and pathological cases were studied and the results were compared with these obtained by the azo-dye method.