Israel Urca

Ferritin-bearing lymphocytes and T-cell levels in peripheral blood of patients with breast cancer

SummaryPeripheral blood lymphocytes bearing surface ferritin and thymus-dependent lymphocyte (T cell) levels were determined in 15 breast cancer patients in stage I–II, 5 in stage III, 10 with benign breast disease, 4 with Thalassaemia, and 25 normal controls. The results of this study demonstrate that a subpopulation of lymphocytes (16.6%) bearing surface ferritin was found in patients with breast cancer in stage I–II. None were demonstrated in patients with either benign breast disease, or with Thalassaemia, the latter known to have high serum ferritin levels, and almost none (1.7%) in normal individuals. A significant decrease in the percentage of ERFC as compared with the percentage of T cells, determined with anti-T cell antiserum (P<0.01), was observed in patients with breast cancer in stage I–II. Yet, the mean T-cell percentage in this group of patients was significantly higher than the mean percentage of T cells in normal controls (P<0.01). In patients with benign breast disease, the percentage of T cells corresponded to the percentage of ERFC and did not significantly differ from those in normals. Stage III breast cancer patients seem to constitute a biologically distinct group, since the ferritin-positive lymphocyte subpopulation disappeared and the percentage of ERFC and T cells returned to the values of normal controls.Overnight incubation of lymphocytes from patients exhibiting a ferritin-positive lymphocyte subpopulation in culture media containing 20% FCS resulted in the removal of ferritin from the surface of the cells and in restoration of the percentage of ERFC.

Sapheno-Femoral Valve Insufficiency in Varicose Veins of the Lower Limb

SFV competence was investigated in 100 patients (189 legs) suffering from varicose veins. The incidence was found to depend on the method used. The simpler clinical methods such as the cough test, percussion test, Trendelenburg test, revealed SFV insufficiency to be between 15.4-21.6%. Using the Doppler ultrasound the incidence increased to 47.6%; by using the MABP, SFV insufficiency was found to be increased 20%. The SFV competence was indicated as playing an important role in the pathogenesis of varicose veins. The phlebologists decision to carry out high ligation and stripping of the saphena magna in patients with varicose veins should be considered only for those cases where the extent of incompetence has been established beyond doubt.

Conservative Treatment of Stasis Ulcer of the Lower Limbs

Our conservative method of treating stasis ulcers of the leg, which is based on counteracting causal factors, was tested in 100 patients. Ninety-one percent of the ulcers healed within 12 months of treatment, and 71% within 6 months. No recurrences have been reported, although the follow-up is still only short-term. Because of these results, we think surgical treatment of stasis ulcers should be undertaken only when the conservative method fails. If surgery is to be done, it should consist of excision and ligation of varices and incompetent perforators, in order to eliminate recurrences.

The Pathology of Sympathetic Ganglia and Peripheral Nerve in Diabetic and Nondiabetic Atherosclerotic Patients: A Comparative Study

From the Department of Surgery B and the Casper Institute of Pathology, Beilinson Medical Center, Petah Tiqva, and Sackler School of Medicine, Tel-Aviv University, Israel. In a previous study’ and other reportS2,3, it was shown that lumbar sympathetic ganglia removed from diabetic patients suffering from atherosclerotic disease of the legs evidenced severe pathological changes. The sympathetic ganglia appeared normal in nondiabetics. In the present study we examined peripheral nerves in 6 patients-3 diabetics and 3 nondiabetics-who were suffering from arteriosclerosis. On photonic and electron microscopy the peripheral nerve of the 3 nondiabetic patients appeared normal. Examination of the peripheral nerve of the 3 diabetic patients showed severe pathologic changes in both myelinated and unmyelinated fibers. In the same patients the sympathetic ganglia revealed extensive degenerative changes not found in the nondiabetics. We conclude that diabetic patients suffer from lesions of both peripheral and autonomic Nervous System. In Atherosclerotic patients without diabetes, they were normal.

Restoration of muscle-pump function in chronic venous insufficiency.

The direct venous pressure profile was recorded before and after treatment in 15 patients suffering from chronic venous insufficiency. Patients were treated conservatively, first by tight elastic support and walking exercises, then by eliminating the points of blood shunting by sclerotherapy of the incompetent perforators. The average venous pressure drop during tiptoeing was increased from 31.6% to 50.9% (P less tan 0.01), and the time required for return to the resting venous pressure level increased from an average 6 seconds to 12.9 seconds (P = 0.01). These values indicate a significant improvement in the functioning of the muscle pump of the calf, and are paralleled by clinical and subjective improvement. Wr recommend this method of treatment in cases of chronic venous insufficiency. We also wish to point out the importance of repeated direct venous pressure profile recording as a means of assessing the effectiveness of treatment in cases of venous disorders.

Small bowel complications probably due to Largactil therapy

Abstract A case is described of a thirty-seven year old paranoid schizophrenic man who had clinical and repeated radiologic signs of duodenal ulceration. In view of his psychiatric history he was treated for ten days preoperatively with Largactil. At operation no duodenal ulcer was demonstrated but violet-red patches were seen on loops of the small bowel. Biopsy revealed inflammatory infiltration rich in leukocytes and eosinophils. The histologic picture is identical to that found in patients with Largactil-induced lesions in various other organs. The side effects of Largactil are discussed and the literature is reviewed.