Gerald Mandell

Acute myelomonocytic leukemia in a patient with macroglobulinemia and malignant lymphoma

Acute myelomonocytic leukemia occurred in a 69‐year‐old man with malignant lymphoma and macroglobulinemia. Fluorescent staining demonstrated the macroglobulin in plasma and leukemic cells. Plasma cells seemed to be producing paraproteins, while leukemic cells appeared to be engulfing them as seen with transmission electron microscopy. The sequence of events ruled out the possibility that myelomonocytic leukemia developed following the use of cytotoxic drugs. The case presented in this report is a rare example of malignant lymphoma, macroglobulinemia, and acute myelomonocytic leukemia occurring in the same patient.

Peritoneal lavage and filtration for cytology

Abstract A technique for cul-de-sac peritoneal lavage and filtration is described. Preliminary experience with this procedure suggests its mass application may result in earlier cytologic diagnosis and increased salvage of patients with clinically occult intra-abdominal malignant disease.

An Extravascular Left Ventricular Assist Device

The hemodynamic efficacy and prosthesis-vessel interaction of a pneumatically activated circulatory assist device was investigated in 12 acute and 12 chronic studies in dogs. A polyurethane balloon encased in Dacron-velour cloth was fastened to the descending thoracic aorta with a spiral wrapping of Dacron graft material. Diastolic augmentation was provided by rhythmic inflation and deflation of the balloon. Hemodynamic results, based on 5 dogs with experimental myocardial ischemia, showed that left ventricular systolic peak pressure decreased by 8.2 +/- 1.9%, cardiac output increased by 13.1 +/- 2.8%, and circumflex coronary artery flow rose by 17.5 +/- 2.5%. In the chronic experiments the prosthesis was asynchronously but continuously activated from one to sixteen weeks at 74 cycles per minute. Postmortem examination of the implantation site in all 12 dogs showed that necrosis had developed but was limited to the outer half of the medial layer beneath the pumping chamber and that the aortic wall was compressed to about 70% of its original thickness. Although the method described represents a simple form of providing ventricular assistance, its applicability for long-term circulatory support remains to be evaluated.