Ralph Zalusky

Coexistence of Pernicious Anaemia and Chronic Myeloid Leukaemia: An Experiment of Nature Involving Vitamin B12 Metabolism

Summary. Chronic myeloid leukaemia (CML) and pernicious anaemia (PA) coexisted in a 51‐yr‐old man (who also had myasthenia gravis). His serum vitamin B12 level was normal instead of the high value expected in CML, or the low value expected in PA. Short‐term culture of his peripheral blood cells showed deranged DNA synthesis of the type observed in vitamin B12 deficiency, indicating that his ‘normal’ serum vitamin B12 level was not associated with normal amounts of vitamin B12 available to his CML cells. A tracer dose of 0.45 μg of[57 Co]vitamin B12 disappeared abnormally slowly from his serum over 24 hr (as previously observed by others in patients with either CML or PA). A therapeutic injection of vitamin B12 appeared to disappear abnormally slowly from his serum over a period of 2 yr. His serum showed a markedly elevated unsaturated vitamin B12 binding capacity, with a less sharp increase in percentage of vitamin B12 binding α as compared to β globulin than usually expected in CML.

Human immunodeficiency virus-related lymphoreticular malignancies and peripheral neurologic disease. A report of four cases

The most common human immunodeficiency virus‐related (HIV) malignancies to date include Kaposis sarcoma and the high‐grade non‐Hodgkins lymphomas. There also appears to be an association between HIV and an aggressive form of Hodgkins disease. In addition, there is a spectrum of HIV‐related central and peripheral neurologic syndromes. This article documents four patients with HIV‐associated lymphoma who presented with peripheral neurologic syndromes as part of their neoplastic process. Autopsy results obtained from two of these patients showed direct nerve infiltration by lymphoma. All patients had an elevated serum lactate dehydrogenase (LDH). It is recommended that HIV‐related lymphoma be considered in a high‐risk patient who presents with a peripheral neurologic syndrome especially if there is an elevated serum LDH.

Studies on the Mechanism of Erythrocytosis Associated with a Uterine Fibromyoma

Summary. Erythrocytosis has occasionally been associated with uterine fibromyoma and attributed to an inappropriate elaboration of erythropoietin (Ep) by the tumour. Whether Ep per se, its precursor substrate, or activator analagous to the renal erythropoietic factor (REF) is produced, has not been defined. In a 54‐yr‐old woman with erythrocytosis and uterine fibromyoma, plasma, urine and tumour extracts were examined to clarify these possible mechanisms. Preoperatively, elevated serum and urinary Ep were present with constant levels over a range of haematocrits induced by serial phlebotomy. Extracts of the tumour did not generate Ep when incubated with normal serum, nor did they contain substrate activity for known REP. Tumour extracts did, however, possess Ep activity which was abolished with anti‐Ep. The patient has remained haematologically normal more than 1 yr following surgery. The data show that the erythrocytosis associated with uterine fibromyoma is mediated through the direct production of Ep by the tumour and not by a substrate‐REF‐like mechanism as found in the normal kidney.

Lack of erythropoietic inhibitory effect of serum from patients with congenital pure red cell aplasia

The serum from five children with congenital pure red cell aplasia demonstrated no erythropoietic inhibitory effect either in vivo in animals or in vitro. The significance of immunosuppressive therapy in this disease is discussed.

Light chain myeloma with meningeal and pleural involvement

A 76-year-old woman with newly diagnosed lambda light chain myeloma was found to have involvement of the pleura and meninges. Direct immunofluorescence demonstrated the monoclonal nature of plasma cells found in the pleural fluid; morphologically similar cells were found in the cerebrospinal fluid and bone marrow. Immunoelectrophoresis revealed lambda light chains in the pleural fluid and cerebrospinal fluid, as well as in the serum and urine. Clinically apparent pleural involvement and meningeal involvement by myeloma are each rare events. This is believed to be the first report of both phenomena occurring simultaneously and the first known case of light chain myeloma involving the cerebrospinal fluid.