Double labelled T suppressor lymphocytes in the thymus of a patient with myasthenia gravis: morphological and immunological characteristics.

Double labelled lymphocytes were prevalent in the thymus of a 32-year-old woman with myasthenia gravis. The simultaneous presence of both E and C3b surface receptors was demonstrated. Focal paranuclear acid phosphatase activity of the cells supported their T cell origin. Histological analysis revealed a hyperplastic thymus with germinal centres in one lobe and an unusual transition to "thymoma-like" diffuse sheets of thymocytes and large thymic epithelial cells in the other lobe. Immunological studies of isolated cells from the "thymoma-like" region revealed a high percentage of E rosettes (96%), EAC rosettes (87%) and IgG-EA rosettes (60%). The large number of "active" rosettes (94%) indicated high avidity of receptors for sheep red blood cells. The postoperative accumulation of acid phosphatase positive T cells with C3b surface receptors in the peripheral blood was striking. These characteristics suggest that this cell population represents an activated T subset (TG) with a certain degree of immaturity similar to a particular stage of foetal T cell development (prothymocytes).

Surgery of venous leg ulcers.

Numerical data are presented to prove the endemic nature and importance of the varicose and postthrombotic syndrome. The fact that even in the most fortunate cases conservative therapy can bring about only temporary improvement, has directed attention to surgical methods. The surgical methods of treatment of varicos (VS) and postthrombotic (PS) syndrome are reviewed. The surgical procedure considered adequate is described. It consists of the following steps. After phlebography, in the case of satisfactorily functioning deep veins, the superficial venous system is extirpated according to Trendelenburg, Madelung and Babcock, the insufficient perforants are exposed and ligated, the ulcer is excised deeply and broadly into the intact tissue. The effect is covered at a later date with a semi-thick skin graft. The importance of supplemental conservative methods (preparation and postoperative treatment) is stressed. This complex therapy was applied in 112 severe cases of venous failure; in 96% the result was excellent, in 3% adequate and in 1% poor. The guiding principles for the successful solution of chronic venous failure are a correct diagnosis and a correctly performed operation. Only proper care can guarantee good results.