Flow cytometric detection of erythropoietic cytotoxicity in mouse bone marrow.

Erythroblast proliferation and maturation in bone marrow are the processes leading to the formation of polychromatic erythrocytes (PE) and normochromatic erythrocytes (NE), respectively. PE contain RNA but no DNA, and can therefore be distinguished both from NE (which lack both RNA and DNA) and from nucleated cells (which contain both DNA and RNA). Cytotoxic agents that induce impairment of the maturation process change the PE:NE ratio. We have developed a simple and rapid method of determining the PE:NE ratio, based on flow cytometric analysis of formaldehyde-fixed, acridine orange (AO)-stained cells. The effects of cyclophosphamide (CP), mitomycin C (MMC), and vincristine (VC) were tested and the PE:NE ratio was evaluated over 7 days of treatment. In this study we monitored the kinetics of these compounds and were able to demonstrate both a time- and a dose-dependent effect. We detected a difference between the effects of the alkylating agents tested and those induced by the spindle inhibitor tested. Flow cytometry of fixed bone marrow samples stained with AO provides more information, better and more rapid statistical analysis, than conventional microscopic methods for counting the PE:NE ratio.

High-dose methylprednisolone pulse therapy in sarcoidosis.

Intravenous methylprednisolone in "pulse" dose (30 mg/kg, once a week for 6 weeks) with or without oral maintenance corticosteroid therapy was administered to 12 patients with chronic sarcoidosis. Disease activity was evaluated by broncho-alveolar lavage, serum angiotensin converting enzyme assay and 67Ga scanning. Efficacy was assessed by clinical, radiological, and functional data. Pulse methylprednisolone produced immediate improvement in all patients but eight of the 12 patients relapsed 1 year later; one patient without maintenance corticosteroids and three patients with maintenance oral corticosteroids showed persistent improvement. However, there was no significant difference in criteria of disease activity of each patient before pulse therapy and 1 year later (p greater than 0.5). In conclusion, high dose therapy has immediate but transient effects whether or not it is supplemented by conventional corticosteroid therapy at the lower maintenance dosage.

Activated alveolar macrophage and lymphocyte alveolitis in extrathoracic sarcoidosis without radiological mediastinopulmonary involvement.

Cellular characteristics of BAL were investigated in 18 patients with proved extrathoracic sarcoidosis (that is, sarcoidosis that affected the skin, eyes, parotid glands, stomach, nose, kidneys, or meninges) without clinical or radiological mediastinopulmonary involvement. Computed tomography of the thorax was performed on five patients: four patients were normal, and one had enlarged lymph nodes (these enlargements were not detectable on the patient's chest roentgenogram). The results of pulmonary function tests were normal in all patients. The total BAL cell count did not differ significantly between controls and patients. Abnormal percentages of alveolar lymphocytes (from 18 to 87%) were noted in 15 out of 18 patients. SACE levels were normal in 15 patients. No pulmonary gallium uptake was detected. The chemiluminescence of AM's, whether spontaneous or PMA induced, was increased in five out of seven patients. The percentages of T3+ lymphocytes in sarcoidosis patients did not significantly differ from those in controls. The T4+:T8+ ratio was normal in four patients and slightly increased in one. Follow-up of patients showed that alveolar lymphocytosis is as lasting as extrathoracic involvement. Our data demonstrate increased percentages of lymphocytes and activated AM's in the BAL of patients with extrathoracic sarcoidosis. This may be due to the initial involvement of the respiratory tract in extrathoracic sarcoidosis or to the diffusion of activated macrophages and lymphocytes from an extrathoracic site into the lung.

[Thoracic actinomycosis. Apropos of 5 cases]. / L'actinomycose thoracique. A propos de 5 observations.

Described for the first time by Bradshaw in 1846, actinomycosis is a rare, slowly progressing disease associated with the development of anaerobic bacteria of the Actinomyces genus. It predominates in males and is actively encouraged by poor buccal and dental hygiene and by overall decline of defence mechanisms. Thoracic lesions constitute 15 to 20% of the cases and seem to be relatively increasing. Apart from fistulization to the skin, physical examination usually does not show much; only the presence of yellow grains suggests the diagnosis. Radiography is often misleading, suggesting tuberculosis or cancer. Ultrasonography and, chiefly, computerized tomography are the best methods to evaluate the extension of the disease to the pleura, the chest wall and the mediastinum. The final diagnosis is more often supplied by pathological examination than by bacteriology, which is frequently negative. Treatment is facilitated by the fact that Actinomyces is sensitive to antibiotics, notably to penicillin which still is the first choice drug. A well-conducted treatment will give satisfactory results, but sequelae of retractile fibrosis may be disabling.

[Allergic bronchopulmonary aspergillosis. Apropos of 30 cases]. / L'aspergillose broncho-pulmonaire allergique. A propos de trente observations.

Thirty cases of allergic bronchopulmonary aspergillosis (ABPA) were treated between 1967 and 1981. Developing in patients with a history of chronic asthma (28 of the 30 cases), the initial manifestations of ABPA developed after long periods (an average of 29 years after the onset of the asthma). Chest radiography demonstrated recurrent labile infiltrates in 28 cases, segmental or lobar atelectasis in 7, and proximal bronchiectasis in 16 cases. A circulating eosinophilia was a constant finding, but this varied with time. Immunologic investigations gave positive skin tests, 19 of the 30 patients only presenting a cutaneous reaction delayed until the 6th hour. Total IgE, determined in 18 cases, varied between 600 and 9400 IU/ml (RIST), with identification of specific IgE for Aspergillus in all cases, though to varying degrees. Serial measurements of total IgE levels showed co-existence of an acute progression of the affection and elevated total IgE in 3 cases, but no correlation was found between serum IgE levels and the severity or chronicity of the disease. Physiopathologic features included immediate and partially delayed hypersensitivity to Aspergillus fumigatus. The frequency of ABPA during the course of mucoviscidosis suggests, by analogy, that a local factor may exist which favorizes Aspergillus fumigatus proliferation in patients with ABPA alone.