Edward C. Lynch

A patient with Wegener's granulomatosis exhibiting unusual clinical and morphologic features

Abstract A patient with Wegeners granulomatosis is presented in whom several unusual manifestations were observed, including cerebral arteritis, an aneurysm of the left vertebral artery resulting from the arteritis, and three pulmonary cavities with unusually thin walls. The focal glomerular changes observed at necropsy showed regression in severity when compared to those seen in two renal biopsy specimens obtained during life. Renal function remained good, and death was attributed to the cerebral arteritis. The value of renal biopsy in establishing the diagnosis is emphasized. Corticosteroid therapy in doses sufficiently large to suppress completely the inflammatory elements of the disease is recommended.

Granulomatous infections complicating hairy cell leukemia

Of 14 patients with hairy cell leukemia (HCL), four developed opportunistic granulomatous infections: blastomycosis, coccidioidomycosis and two Mycobacterium kansasii. The former two pathogens have not been reported with HCL, while M. kansasii infections appear to be common. While most reviews stress susceptibility to pyogenic bacteria and the predisposing role of iatrogenic factors, three of our patients were infected prior to any therapy. Thus, disease‐related factors predispose to these granulomatous infections. Granulocytopenia and monocytopenia were present; the latter was not often corrected by splenectomy. There was impaired granuloma formation, with all infectious lesions appearing histologically as focal microabscesses containing few macrophages. Awareness of the frequency of opportunistic intracellular infections with early consideration of invasive diagnostic procedures to establish specific etiologic diagnosis may greatly prolong survival for many HCL patients.

Reduced erythrocyte deformability associated with calcium accumulation

Abstract Erythrocytes exposed to subhemolytic shear stress in vitro exhibit decreased deformability as determined by a filtration method. Intracellular calcium content of these cells has been measured by atomic absorption spectroscopy and found to be 35 and 55% higher than controls (0.0157 μmol/ml packed red blood cells) after shear stress levels of 100 and 130 N/cm 2 , respectively. These alterations occur without significant changes in ATP level, intracellular magnesium content, cell volume, or morphology, and without large associated sodium and potassium fluxes. Results indicate that calcium may be responsible for or associated with changes in the viscoelastic properties of the red cell membrane caused by sublytic mechanical trauma.

Plasma cell dyscrasia with marrow fibrosis. Clinicopathologic syndrome

Five new cases of plasma cell dyscrasia with coexistent myelofibrosis are described and six previously reported cases are reviewed. Four of the new patients and two from the literature had features of a previously unrecognized syndrome. This syndrome was characterized by significant paraprotein levels, marked marrow fibrosis, and plasmacytosis, without features of extramedullary hematopoiesis (agnogenic myeloid metaplasia) and leukoerythroblastosis. These patients were generally severely anemic and commonly leukopenic and thrombocytopenic. In contrast, one of the new patients and four in the literature showed classic features of the myeloproliferative disease, myelofibrosis with agnogenic myeloid metaplasia, along with features of typical multiple myeloma.

Forty-one Variables Following Thoracotomy in Calves

Seven calves underwent thoracotomy to study the response of 41 physiologic variables over a 14 day post-operative period for comparison to a recent series of left ventricular bypass pump implants. The experimental protocols were identical to the pump implant protocols except that the sham operated animals did not receive antiplatelet or anticoagulant drugs and the pumps were not implanted. Of the 41 variables studied, 13 changed significantly during the post-operative period. Heart rate, hematocrit, whole blood hemoglobin, and fibrinogen concentration decreased, while fibrinogen survival, stroke volume, cardiac output, arterial blood pH, pCO2 and pO2, plasma sodium concentration, and urinary excretion rates of sodium and potassium increased from the first or second to the fourteenth post-operative day. Heart rate and hematocrit also decreased in the recent series of 18 animals in which left ventricular bypass pumps were implanted. The decrease in heart rate is toward the unoperated control value as the calves recover from the operative stress. The decrease in hematocrit is probably the result of daily removal of blood for the physiologic studies because there was no evidence of hemorrhage or red blood cell destruction.