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Biomedical subjects

F Schmalzl

Publications and source records attributed to F Schmalzl.

17 recordsLinked to original sources

[Subacute and chronic monocytic leukemia: diagnostic and clinical problems].

The authors report on 16 cases of either subacute (SMML) or chronic (CMML) myelomonocytic leukemia as well as chronic monocytic leukemia (CMoL). All these cases were oligoblastic and, according to their clinical course, they could be termed as smouldering leukemias. The chronic types affected mainly males. The diagnostic cytomorphological and cytochemical criteria are discussed. Erythro- and thrombocytopoiesis were distinctly less impaired than in acute leukemias (AL). The leucocyte count in the peripheral blood of the SMML cases was within the normal range. Hepato- and splenomegaly were markedly increased as compared to AL. According to our materials leukemic skin infiltrations were less frequent in CMoL, CMML and SMML than in acute monocytic leukemias. In each of the three types of leukemia discussed monocytic leukemic cells could be readily identified by cytochemical tests and usually showed fairly normal maturation. In accordance with these observations lysozyme levels in urine and serum usually were strongly increased. The patients in the CMML and CMoL groups showed a mean survival of more than 13 months (2 out of 7 are still alive), whereas the SMML patients survived an average of 8 months. Deaths were frequently due to advanced age rather than to leukemia. In other cases a terminal accumulation of blasts marked a transition to acute leukemia. During the smouldering phase of the disease no beneficial effect of combined chemotherapy could be noted. Supportive and symptomatic therapy might improve length and quality of survival.

Aged

[Prolymphocytic leukaemia (author's transl)].

Prolymphocytic leukaemia occurred in two women aged 75 and 57 years, respectively. In both instances the lymphatic cells fulfilled the morphological criteria of the disease picture. In one patient the disease was characterised by immunological and physical methods as being a B-cell lymphoma, in the other a T-cell lymphoma. Acid phosphatase was of special significance among cytochemical studies. While the patient with the T-cell lymphoma died after three months, the one with B-cell lymphoma is still alive 16 months later. Splenectomy resulted in marked improvement in the latter patient's condition and may turn out to be the treatment of choice in prolymphocytic leukaemia.

Aged

[Bone marrow culture in aplastic anemia and preleukemias].

After incubation of bone marrow cells obtained from normal subjects and patients with pancytopenia in the double layer agar culture (Robinson-Pike), the clusters of different size and the colonies were counted on days 2, 3, 5, 7 and 10. Aplastic anemia and two types of preleukemia could be distinguished by a different growth pattern. A high incidence of small clusters (4-12 cells) was found in patients with aplastic anemia on days 2 and 3, whereas these aggregates were markedly reduced in preleukemia of type B. In preleukemia of type A an excessive number of small clusters was obtained. The morphology of cells in clusters and colonies was studied by cytochemical staining and electronmicroscopy. In preleukemia marked defects of maturation were demonstrable in the cells.

Anemia, Aplastic

[Prolymphocytic and hairy cell leukemias as special forms of chronic lymphatic leukemia].

Cytochemical and immunological studies were performed on "hairy" cells from 5 patients. The results, primarily the detection of surface immunoglobulins after incubation in immunoglobulin-free medium support the hypothesis that hairy cells are B-cells. Further parameters for B-cell lineage are the failing suppression of unspecific esterases by NaF, the presence of tartrate-resistant acid phosphatase and the absence of phagocytic capacity and glass adherence (skin window). A lysozyme could not be demonstrated. Of two patients with prolymphocytic leukemia one was characterized as T- and one as B-cell leukemia. Therefore, the prolymphocytic leukemia has to be discussed as intermediate form of ALL and CLL. In both patients the therapeutic results were discouraging with cytostatics (e. g. chlorambucil), splenectomy is considered as the treatment of choice.

Diagnosis, Differential

[Cytochemical aspects in bone marrow cells in macrocytic anemias].

Cytochemical investigations are useful for the characterization of different kinds of macrocytic anemias. Vitamin B12 and folate defects or chronic alcoholic myelopathy, induce in the erythroblasts cytochemical patterns which can be distinguished from those seen in preleukemia, erythroleukemia, or in drug induced toxic anemia. Tests for alpha-naphthol-acetate-esterase, for acid phosphatase, for iron, and for polysaccharides (PAS-stain), are especially valuable for these diagnostic procedures.

Anemia, Macrocytic

[Lymphomatoid granulomatosis primarily affecting the skeletal muscles].

The authors report on a woman (34 years old) which was affected by lymphomatoid granulomatosis. During the first periods of the disease the granulomatous lesions were confined to the muscles of the upper extremities. High fever, progressive development of new muscular lesions and later of lesions in the pharynx, larynx, and the lungs characterized the clinical course. Therapeutic approaches included glucocorticoids, chemotherapy, irradiation, plasmapheresis, but induced no relevant beneficial effect. Based on laboratory and experimental data as well as on data from the literature the authors discuss the pathogenesis and differential diagnosis of this disorder.

Adult

[The index of leukocyte alkaline phosphatase in patients with hemodialysis (author's transl)].

The index of the leukocyte alkaline phosphatase activity (LAP-I) was evaluated in 15 patients suffering from chronic uremia immediately before and after hemodialysis, as well as 16 or 18 and 40 or 42 hours thereafter. Immediately following hemodialysis the LAP-I was significantly reduced in comparison with to predialysis values. 16 and 18 hours after hemodialysis the LAP-I had again increased and at 40 and 42 hours exceeded the starting predialysis values. These results are discussed in relation to the dialysis-induced decrease of plasma cortisol and to the consequent ACTH and cortisol overproduction.

Adolescent

[Significance of PAS-positive myeloblastic leukemia].

We refer to 48 adult patients suffering from acute myeloblastic leukemia, whose leukemic cells showed a typical cytochemical pattern: i.e. weak staining for peroxydase and with sudanblack B and lacking or only weak staining for nonspecific esterase. In 8 patients the leukemic myeloblasts additionally showed distinct granular staining for polysaccharides using the PAS-reaction. The therapeutic response, the remission rate and the survival time of these 8 cases have been compared to those of 40 patients, whose leukemic myeloblasts differed exclusively in the absence of granular PAS-positive materials. Out of the latter PAS-negative cases 7 patients (18%) went into a complete remission (M1, P1), 5 patients achieved partial remission (M2, P1-2), the 50%-survival time was 4.9 months. Out of the 8 granular PAS-positive cases 4 patients (50%) went into complete (M1, P1), and 1 reached partial remission (M2, P1-2). The 50%-survival time of the cases now lasts 10.1 months and three patients are still alive and in persisting complete remission 19, 12.5 and 12 months after diagnosis. These results suggest a better prognosis and an improved therapeutic response in those myeloblastic leukemias which additionally contain cytoplasmic granular PAS-positive materials.

Adult

[Clinical and cytological differences in adult acute lymphatic and acute undifferentiated leukemia].

The usefulness for clinical purposes of the distinction of acute undifferentiated (AUL) and acute lymphocytic leukemia (ALL) is suggested by the following observations: 1. Maturation from AUL to ALL has not been observed. Transformation of ALL to AUL has been reported i.e. less of cytoplasmic polysaccharides; however this seems rather to be the effect of cytotoxic therapy and not a real change of the cytological type. 2. Significant differences among ALL and AUL can be noted as far as the therapeutic response is concerned: All of the 9 patients with ALL but only 2 out of 9 patients with AUL went into remission. The mean survival of the cases with ALL amounts to 34, that of AUL only to 4 months. Out of the patients with ALL 4 patients are still alive in persistant first remission after 77, 57, 36 and 28 months. 3. ALL occurs most frequently in young adults (mean age of 21 patients: 31.7 years): AUL is more frequent in elderly patients (Mean age of 18 patients: 57.6 years). 4. In our material ALL did never occur consequent to a typical preluekemic stage, which was followed either by myeloblastic, monocytic, erythroleukemic or undifferentiated leukemias.

Adolescent

[Plasmocytoma, alkylating agents, and acute myeloid leukemia (author's transl)].

Two cases of the development of acute myeloid leukemia (AML) after treatment with alkylating agents are reported. In Case 1, melphalan and then cyclophosphamide had been given for multiple myeloma. 46 months after onset of cytostatic treatment AML occurred, as confirmed cytochemically and by qualitative determination of urinary lysozyme. In Case 2, cyclophosphamide had been given for rheumatoid arthritis. After a latency of 34 months 'smouldering leukaemia' developed with an atypical monocytic leukaemic cell population. In a third case, multiple myeloma and monocytic leukaemia developed synchronously. The causative role of melphalan and cyclophosphamide in the development of AML seems securely established. Despite the risk of alkylating agents in the treatment of multiple myeloma or Hodgkin's disease causing AML, they should not be replaced, as other drugs have been shown to be less beneficial. On the other hand, alkylating agents should be used with great caution in the treatment of non-malignant diseases.

Aged

[Different maturation of leukemic blasts in tumor--like type of acute infantile leukemia (author's transl)].

In condition, it has been found that an acute infantile leukemia in its early stages, manifested itself clinically and morphologically as a reticulosarcome. Through cytochemical examinations, the malignant disease could be identified as an acute myeloid leukemia. The blasts in the tumourous tissues show less differentiation than the leukemic blood and bone marrow cells. The lack of maturation of the blasts is discussed as the cause of tumorlike cell growth.

Bone Marrow Cells