John E. Kurnick

Felty's syndrome: Effect of lithium on granulopoiesis

The effect of lithium carbonate upon granulopoiesis was studied in eight patients with Feltys syndrome. Absolute granulocyte counts increased in all patients receiving 900 mg lithium carbonate daily for six weeks. Increased urinary and serum granulocyte colony-stimulating activity was observed in all patients during lithium therapy. A casual relationship between increases in colony-stimulating activity and increased granulocytes is postulated.

Serum level of erythropoietin in anemias associated with chronic infection, malignancy, and primary hematopoietic disease

The serum level of erythropoietin was measured in 31 patients with anemia secondary to chronic infection or malignancy and compared with erythropoietin levels in 23 patients with iron-deficiency anemia and 14 patients with primary hematopoietic diseases. Erythropoietin levels varied directly with the degree of anemia in patients with iron deficiency or primary hematopoietic disorders. There was no correlation of erythropoietin and the degree of anemia in patients with chronic infection or malignancy and the erythropoietin levels were significantly lower than in patients with iron deficiency or primary hematopoietic disease and the same degree of anemia. A major factor in the anemia of chronic disorders is a decrease in levels of erythropoietin.

Involvement of the heart and pericardium in the malignant lymphomas.

Seventeen patients with lymphomatous involvement of the heart or pericardium were studied. The series includes eight patients with Hodgkins disease and nine with non-Hodgkins lymphoma. All 17 had radiologic evidence of pulmonary, pleural, or mediastinal involvement. Cardiac or pericardial disease in seven was apparently due to direct extension of other intrathoracic tumor masses. Cardiac involvement was usually a late manifestation of lymphoma with median onset 20 months after initial diagnosis. Fourteen patients had been treated for stage IV disease prior to the onset of cardiac lymphoma. Only seven of the 17 patients with cardiac involvement were diagnosed antemortem. Four of them are alive without evidence of disease 8 to 68 months after diagnosis and treatment. Because cardiac lymphomas may respond to therapy with prolonged survival, it is imperative that clinicians suspect cardiac or pericardial involvement in lymphoma patients who have radiographic evidence of intrathoracic lesions (especially adjacent to cardiac borders), unexplained tachyar-rhythmia or conduction disturbance, evidence of outflow obstruction, or signs and symptoms suggesting pericardial effusion or tamponade.

In Vitro Granulocytic Colony-Forming Potential of Bone Marrow from Patients with Granulocytopenia and Aplastic Anemia

Summary The colony-forming potential in agar-gel of bone marrows from patients with aplastic anemia and granulocytopenia has been studied. It has been shown that bone marrow cells from these patients retain the ability to produce colonies in vitro, but that the number of colonies formed is reduced compared to normal human bone marrow. No inhibitory effect of serum or plasma from patients with aplastic or granulocytopenic states was found upon the colony growth of normal human bone marrow.

Presence of a Myeloproliferative Factor in Patients with Polycythemia Vera and Agnogenic Myeloid Metaplasia I. Expansion of the Erythropoietin-Responsive Stem Cell Compartment

Summary The presence of a factor in patients with the myeloproliferative syndrome that enhances the effect of erythropoietin on the EP-responsive stem cell was evaluated in hyper-transfused mice. The serum of four patients with agnogenic myeloid metaplasia and four of five patients with polycythemia Vera significantly increased the effect of a standard dose of EP. The serum of four patients with chronic granulocytic leukemia and one patient with idiopathic leukocytosis failed to enhance the response to EP. The enhancing effect could not be ascribed to EP in, the injected serum. Evidence is presented that the serum factor either expands the number or increases individual sensitivity of the EP-responsive stem cells. Failure to find this factor in chronic granulocytic leukemia suggests a different control mechanism in leukemia from the other myeloproliferative disorders.