Immunoglobulin D benign monoclonal gammopathy. A case report.

The authors report a case, perhaps the first, of immunoglobulin D (IgD) benign monoclonal gammopathy. The patient, a 48-year-old black woman, initially had a 500 mg/dl IgD-lambda M-spike, hypercalcemia, and anemia. There was no bone pain, lytic bone lesions, or evidence of renal failure. The bone marrow showed 2.8% plasma cells with a diffuse (not nodular) IgD plasmacytosis and strong lambda predominance. Only trace amounts of free lambda light chains could be demonstrated by immunoelectrophoresis in serum and concentrated urine. The anemia responded quickly to iron therapy. Chemotherapy was not initiated. Over the 6+ years of follow-up, the patient has had no progression of clinical disease attributable to her IgD monoclonal gammopathy. The IgD M-spike has steadily decreased.

Intervertebral disk material: criteria for determining probable prolapse.

To develop histologic criteria that allow distinction of prolapsed from nonprolapsed intervertebral disk material, we reviewed the histologic features of curetted fibrocartilage from 100 consecutive patients having documented disk prolapse into the spinal canal and contrasted our findings to those in 40 intervertebral disks removed at autopsy from 20 patients without prolapse. Neovascularization, occurring at the edges of fibrocartilage fragments, was present in 50% of prolapsed disk specimens and in none of the control autopsy disks (p = 0.0004). Other histologic features sometimes used as evidence of degeneration and/or prolapse (i.e., fibrillation, chondrocyte "cloning," and granular change) were not helpful in distinguishing prolapsed from nonprolapsed control disks. Although this indicator was only 50% sensitive in our series, we propose that edge neovascularization of the fibrocartilage fragments is the only reliable histologic clue that intervertebral disk prolapse has occurred.

Antibody-dependent cellular cytotoxicity with platelets as the target cell: potential application to the study of immune thrombocytopenia.

Antibody-dependent cellular cytotoxicity (ADCC) with platelets as the target cell is demonstrated with white blood cells, platelets and anti-platelet antibody obtained from marmosets. Greatest ADCC activity was observed with cell populations enriched for polymorphonuclear (PMN) cells and adherent cells. Non-adherent cells and lymphocytes obtained from blood pretreated with carbonyl iron showed a lower yet significant degree of activity. The virtual absence of PMNs and monocytes from these preparations indicates that a non-phagocytic-mediated destruction of platelets can occur by an ADCC process. Platelets having IgG deposited on them as a consequence of an autoimmune reaction following an interspecies platelet immunization are not necessarily susceptible to lysis by an ADCC mechanism. The ADCC reaction system as described and the results obtained suggest one can monitor platelets, effectors and soluble factors from immune thrombocytopenic patients and animals with respect to this mode of destruction in vivo.

Selective mass treatment in a venereal disease control program.

To control syphilis among prostitutes and seasonal farm workers in Fresno County, California, we developed a program of selective mass treatment of prostitutes. From August 1976 to July 1977, 512 women entered the program. Overall, 4.6 per cent of women treated prophylactically for syphilis were actually infected. Compared to cases in the previous year, infectious syphilis cases among prostitutes and seasonal farm workers decreased 51.3 per cent and 26.8 per cent, respectively.

Medical education and family planning---III. What departments of preventive and social medicine are doing in India.

PIP: Medical colleges in India have been urged to increase the quality and quantity of teaching on population dynamics and family welfare planning since 1957. The recommendations of the Deans and Principals Conference of August 1967 and the directive of the Medical Council of India issued in August of 1968 outline a syllabus and present many suggestions about the ways in which a number of departments should contribute to the teaching of these subjects during the years of the undergraduate medical curriculum. The Preventive and Social Medicine (P and SM) department is involved in teaching these subjects. In order to determine to what extent the recommendations and directives were being implemented, a questionnaire was sent to the head of the department of P and SM in each of the 93 medical schools in India to ask what that department had done in the 1968-1969 academic year. It was determined that the departments of P and SM were devoting an average of 10.8 holrs of lecture or class discussion to teaching family welfare planning and population dynamics. Many departments said they needed more books in the field. About 40% were conducting research on 1 or more related topics. Questions on the subjects were included in examinations by 90% of the departments in their college exams and 75% said that questions on these topics appeared on the written University examinations. 73% of the departments used A-V aids in their teaching of family welfare planning and the same proportion utilized seminars. 1 department required students to insert an IUCD. However, in the internship, 17 departments required women to do so and 7 required men to do 1 or more insertions. 2 departments made it a requirement during the final year to assist tubectomy operations, and 9 departments did so during the internship. 1 department required final year students to do a vasectomy. During internship, 16 required men to do 1 or more vasectomies, and 7 required women to. Shortage of staff was the most frequent difficulty mentioned for implementing the suggested syllabus. The most frequent suggestion for improving teaching was the development of more adequate teaching family welfare planning clinics. It was concluded that compared with departments of P and SM in other countries, the ones in India were devoting a significant, and perhaps an adequate, amount of time to the teaching of family welfare planning and population dynamics.^ieng

Medical education and family planning-II. Implementation of administrative recommendations for the Third Conference of Deans and Principals.

PIP: In 1967 recommendation were made by the Deans and Principals of Medical Colleges on the teaching of population dynamics and family welfare planning in India. A survey was made in 1969 to determine to what extent the recommendations were implemented. 80 percent of the medical colleges returned the questionnaire. 30 percent of those responding had a special committee to promote family planning teaching, research, and service. 30 percent had instituted block teaching of 1 to 4 weeks for family planning during the final year. 80 percent claimed to devote at least 1 month of the internship to maternal and child health and family planning in rural areas. 76 percent utilitzed an urban family planning clinic and 56 percent used a rural family planning clinic in their training. 77 percent of the urban clinics and 56 percent of the rural clinics were under the complete control of the college concerned. Only a few had implemented the resolutions about: 1) staff assignment to rural center (8); 2) prerequisite of rural service before portgraduate study (3); 3) conducting refresher courses (8); and 4) organizing mobile family planning units (13). A number of colleges were concerned about the lack of coordination between departments teaching family planning and shortage of staff to conduct adequate teaching. Many colleges indicated that they were involved in a wide variety of family planning activities both within and outside the campus. Although some colleges did take steps toward the implementation of the recommendation, many did not act.^ieng