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Biomedical subjects
Publications and source records attributed to P M Bakker.
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The proliferating skin cells in a case of acute disseminated histiocytosis-X (Abt-Letterer-Siwe disease) confirmed by electron microscopy, were characterized by a panel of monoclonal antibodies using an immunoperoxidase technique. The "histiocytes" were found to stain with OKT-6 (anti-T6) and anti-HLA-DR antibodies. Unexpectedly, slight staining was also observed with Leu 3a (anti-T4) and OKM-1. A proliferative process of T4, T6, HLA-DR, OKM-1 positive Langerhans' cells has not yet been described and may be specific for histiocytosis-X.
This report deals with the case history of a 21/2-year old Turkish boy, who died from an overwhelming mononucleosis infectiosa. The parents, first cousins, lost already two sons and a daughter. According to the parents, the symptoms of these children resembled those of this boy. In the patient, described here, an acquired immunodeficiency was found, probably induced by the Epstein-Barr virus on the basis of a genetic susceptibility for this virus. The family history, the clinical picture, together with the serological, immunological - and histological examinations, pointed to the diagnosis of X-linked recessive lymfoproliferative syndrome (XLP), as described by Purtilo. The immunological findings resemble those of AIDS (acquired immunodeficiency syndrome).
Immunocompetent cells in exacerbating untreated psoriasis vulgaris skin lesions were immunophenotypically studied by the application of a selection of monoclonal antibodies in a two-stage immunoperoxidase technique. Epidermal changes include: focal accumulation of immunoglobulins in the stratum corneum, as demonstrated by a mixture of monoclonal anti-kappa and anti-lambda antibodies; focal accumulation of OKM-1 positive but Mo-2 negative cells high in the epidermis, reflecting granulocytes in Munro's abscesses; a marked decrease in epidermal Langerhans cells with focal abnormal clumping and smaller dendrites, as demonstrated by monoclonal anti-HLA-DR and anti-T6 (OKT-6) antibodies; and, sporadic exocytosis of mainly T1 (Leu-1), T8 (Leu-2a) positive suppressor/cytotoxic T lymphocytes. The dermal infiltrates were found to consist mainly of partically activated T1 (Leu-1), T4 (Leu-3a) positive T-helper/inducer cells with a smaller compartment of T1 (Leu-1), T8 (Leu-2a) positive suppressor/cytotoxic lymphocytes. These cells were found in close apposition to T6 (OKT-6), HLA-DR positive Langerhans cells and further accompanied by a minor compartment of OKM-1, Mo-2 positive monocytes. No B-cells or plasma cells could be demonstrated in the dermis. Natural killer cells were observed only incidentally. These results fit best with the hypothesis that psoriasis is a chronic inflammatory condition as a result of persistent stimulation of T cells by immunogen(s) of epidermal origin.
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The histories of two Moroccan sisters with pulmonary alveolar microlithiasis are described. Two years follow-up is available. The elder girl has no complaints, her two years younger sister becomes dyspnoeic on exercise. Pulmonary alveolar microlithiasis is a rare condition, which occurs mostly as a familiary disease. On pathologic examination characteristic calcifications are found in the alveoli. The radiographic picture of the chest is quite typical. A short review of the literature is presented.
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Foci of heterotopic nervous tissue, including ganglion-cells, were found in the lungs of an anencephalic foetus. The nine cases in the literature are reviewed. Only in two of these cases was the histological investigation sufficiently detailed to establish the nature of the ectopic tissue. In all but one case the condition was associated with gross malformation of the brain.
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The most dramatic of the complications resulting from central venous catheterization is perforation of the heart. We studied the complications reported in the literature and undertook an original investigation of the dislocations of peripherally and infraclavicularly inserted catheters while moving the arm and shoulder in patients during autopsy. In a postmortem examination of three patients it was found that the greatest displacement, up to eight centimetres, of the tips of the catheters occurred when they were inserted through the basilic vein. The tips of infraclavicular inserted catheters did not move at all during movements of the arm. Only by extreme movements of the shoulder we were able to show a maximal displacement of two centimetres. Advancement of the catheter tip occurred during adduction and flexion of the elbow joint and not during abduction. Our experimental evidence suggests that the best site for a catheter tip is the upper part of the right atrium. We therefore recommend the subclavian route for in-dwelling central venous catheters rather than insertion through an arm vein, as this minimizes the risk of cardiac perforation due to its great stability.
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