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QUALITY AND QUANTITY IN CHEMICAL PATHOLOGY
920
QUALITY AND QUANTITY
IN CHEMICAL PATHOLOGY SiR,-May we add our voices in support of Dr Carter and his colleagues,l who still see a future for chemical
pathologists ? True, superspecialists within the discipline are essential, but surely chemical pathology as a subject is not yet outside a single person’s comprehension. Chemical pathologists, to our way of thinking, are doctors who, though capable of managing a laboratory and developing techniques, have as their basic function the diagnosis of disease and, in some instances, the management of patients in collaboration with their clinical colleagues. They see all biochemical reports on all patients, and over the years they acquire a much wider experience of the value and interpretation of such tests than most clinicians. To be fully effective members of any medical team, however, they must be prepared to meet their clinical colleagues at the bedside in order to keep in touch with patients and the problems clinicians face. We have found many clinical colleagues over many years very happy at finding laboratory workers who show clinical interest, and they certainly make use of one who shows willing. Aspects of chemical pathology outside one’s competence can easily be covered by the " old boy network "-one soon learns which of one’s colleagues give a good opinion on a particular subspecialty. We believe that medicine is already fragmented enough and that the broad view is still extremely useful. Group Laboratory, Watford General Hospital, Watford, Herts. District Department of Pathology, Barnet General Hospital, Wellhouse Lane, Barnet, Herts EN5 3DJ.
B. CHENG.
blood or bone-marrow of acute monocytic leukaemia can induce by their c.s.F. production colony formation from normal bone-marrow. This finding has been confirmed in 10 other cases of this type of leukaemia.5 Furthermore, in all these cases serummuramidase levels were significantly raised. In the case of hairy-cell leukaemia studied the serum-muramidase level was below normal. This has also been found in our leucopenic patients, as in some patients of Burns. These data are probably not decisive against the monocytic origin of the hairy cell, but the conglomerate of techniques exploring different cells properties gives some support to this hypothesis. Department of Hæmatology-Immunology, Hôpital Henri Mondor, 94010
Creteil, France.
CELL-SURFACE STRUCTURE IN HAIRY-CELL LEUKÆMIA
SIR,-Schnitzer and Hammack7 lately presented scanning electron micrographs (S.E.M.) of hairy cells ofleuksmic reticuloendothdliosis (L.R.E., hairy-cell leukmmia) which were identical to those of B lymphocytes. 8 Polliackandhis colleagues then suggested that hairy cells more closely resembled monocytes.9 Now Roath and Newell 10 have demonstrated a mixture of B lymphocytes and hybrid cells with features intermediate between lymphocytes and monocytes in 2 patients with L.R.E. Discrepancies among different studies remind us of three unresolved problems in
EUNICE LOCKEY.
COLONY-STIMULATING CAPACITY OF CELLS OF HAIRY-CELL LEUKÆMIA SIR,-In the controversy about the nature of the cells involved in hairy-cell leukxmia,2 we wish’to present some data which are against their monocytic origin. It has been proved that the monocyte-macrophage system plays a major role in the production of colony-stimulating factor
C. SULTAN M. MARQUET.
L.R.E.:
I. Lack of absolute diagnostic criteria for L.R.E.-The clinical picture, however typical, requires reinforcement by laboratory findings of hairy " cells, ribosome-lamellar complex,is and "
5. Sultan, C., Marquet, M. Unpublished. 6. Burns, C. P. Lancet, 1974, ii, 904. 7. Schnitzer, B., Hammack, W. J. Lancet, 1974, ii, 649. 8. Polliack, A., Lampen, N., Clarkson, B. D., de Harven, E., Bentwich, Z., Siegel, F. P., Kunkel, H. G. J. exp. Med. 1973, 183, 607. 9. Polliack, A., Braylan, R., Golomb, H. Lancet, 1974, ii, 1013. 10. Roath, S., Newell, D. G. ibid. 1975, i, 283. 11. Katayama, I., Nagy, G. K., Balogh, K., Jr. Cancer, N.Y. 1973, 32, 843.
(c.s.F.).3 Thus we compared the colony-stimulating capacity of the hairy cells from a patient with a leukeemic blood picture and that of normal blood monocytes and of monocytes obtained from blood of patients with acute monoblastic leukaemia. By the technique of culture in 4 agar the cells in underlay study were placed in a feeder layer at a concentration of 1 x 106 cells per ml. of medium. On the overlay there were 2 x 105 cells per ml. derived from normal human bone-marrow. Feeder layers have been used for three normal bone-marrows (M,, Mz, M3)The mean number of colonies formed from normal with different sources of c.s.F. were:
marrow
Fig. I-Phase-contrast micrograph of lymphocyte of chronic lymphocytic leukaemia. Fig. 3-Phase-contrast micrograph of monocyte of L.R.E.
It
that the and inducing bone-marrow cells C.S.F.
seems
hairy cells are not capable of providing colony formation from normal human placed on overlay. Monocytes from
Carter, P. M., Davison, A. J., Wickings, H. I., Zllva, J. Lancet, 1974, ii, 1555. 2. Schnitzer, B., Hammack, W. J. Lancet, 1974, ii, 649. 3. Chervenick, P. A., Lo Buglio, A. F. Science, 1972, 178, 164. 4. Pike, B. L., Robinson, W. A. J. Cell. Physiol. 1970, 76, 77. 1.
Fig. 2-Scanning electron micrograph of hybrid cell of L.R.E.
QUALITY AND QUANTITY
IN CHEMICAL PATHOLOGY SiR,-May we add our voices in support of Dr Carter and his colleagues,l who still see a future for chemical
pathologists ? True, superspecialists within the discipline are essential, but surely chemical pathology as a subject is not yet outside a single person’s comprehension. Chemical pathologists, to our way of thinking, are doctors who, though capable of managing a laboratory and developing techniques, have as their basic function the diagnosis of disease and, in some instances, the management of patients in collaboration with their clinical colleagues. They see all biochemical reports on all patients, and over the years they acquire a much wider experience of the value and interpretation of such tests than most clinicians. To be fully effective members of any medical team, however, they must be prepared to meet their clinical colleagues at the bedside in order to keep in touch with patients and the problems clinicians face. We have found many clinical colleagues over many years very happy at finding laboratory workers who show clinical interest, and they certainly make use of one who shows willing. Aspects of chemical pathology outside one’s competence can easily be covered by the " old boy network "-one soon learns which of one’s colleagues give a good opinion on a particular subspecialty. We believe that medicine is already fragmented enough and that the broad view is still extremely useful. Group Laboratory, Watford General Hospital, Watford, Herts. District Department of Pathology, Barnet General Hospital, Wellhouse Lane, Barnet, Herts EN5 3DJ.
B. CHENG.
blood or bone-marrow of acute monocytic leukaemia can induce by their c.s.F. production colony formation from normal bone-marrow. This finding has been confirmed in 10 other cases of this type of leukaemia.5 Furthermore, in all these cases serummuramidase levels were significantly raised. In the case of hairy-cell leukaemia studied the serum-muramidase level was below normal. This has also been found in our leucopenic patients, as in some patients of Burns. These data are probably not decisive against the monocytic origin of the hairy cell, but the conglomerate of techniques exploring different cells properties gives some support to this hypothesis. Department of Hæmatology-Immunology, Hôpital Henri Mondor, 94010
Creteil, France.
CELL-SURFACE STRUCTURE IN HAIRY-CELL LEUKÆMIA
SIR,-Schnitzer and Hammack7 lately presented scanning electron micrographs (S.E.M.) of hairy cells ofleuksmic reticuloendothdliosis (L.R.E., hairy-cell leukmmia) which were identical to those of B lymphocytes. 8 Polliackandhis colleagues then suggested that hairy cells more closely resembled monocytes.9 Now Roath and Newell 10 have demonstrated a mixture of B lymphocytes and hybrid cells with features intermediate between lymphocytes and monocytes in 2 patients with L.R.E. Discrepancies among different studies remind us of three unresolved problems in
EUNICE LOCKEY.
COLONY-STIMULATING CAPACITY OF CELLS OF HAIRY-CELL LEUKÆMIA SIR,-In the controversy about the nature of the cells involved in hairy-cell leukxmia,2 we wish’to present some data which are against their monocytic origin. It has been proved that the monocyte-macrophage system plays a major role in the production of colony-stimulating factor
C. SULTAN M. MARQUET.
L.R.E.:
I. Lack of absolute diagnostic criteria for L.R.E.-The clinical picture, however typical, requires reinforcement by laboratory findings of hairy " cells, ribosome-lamellar complex,is and "
5. Sultan, C., Marquet, M. Unpublished. 6. Burns, C. P. Lancet, 1974, ii, 904. 7. Schnitzer, B., Hammack, W. J. Lancet, 1974, ii, 649. 8. Polliack, A., Lampen, N., Clarkson, B. D., de Harven, E., Bentwich, Z., Siegel, F. P., Kunkel, H. G. J. exp. Med. 1973, 183, 607. 9. Polliack, A., Braylan, R., Golomb, H. Lancet, 1974, ii, 1013. 10. Roath, S., Newell, D. G. ibid. 1975, i, 283. 11. Katayama, I., Nagy, G. K., Balogh, K., Jr. Cancer, N.Y. 1973, 32, 843.
(c.s.F.).3 Thus we compared the colony-stimulating capacity of the hairy cells from a patient with a leukeemic blood picture and that of normal blood monocytes and of monocytes obtained from blood of patients with acute monoblastic leukaemia. By the technique of culture in 4 agar the cells in underlay study were placed in a feeder layer at a concentration of 1 x 106 cells per ml. of medium. On the overlay there were 2 x 105 cells per ml. derived from normal human bone-marrow. Feeder layers have been used for three normal bone-marrows (M,, Mz, M3)The mean number of colonies formed from normal with different sources of c.s.F. were:
marrow
Fig. I-Phase-contrast micrograph of lymphocyte of chronic lymphocytic leukaemia. Fig. 3-Phase-contrast micrograph of monocyte of L.R.E.
It
that the and inducing bone-marrow cells C.S.F.
seems
hairy cells are not capable of providing colony formation from normal human placed on overlay. Monocytes from
Carter, P. M., Davison, A. J., Wickings, H. I., Zllva, J. Lancet, 1974, ii, 1555. 2. Schnitzer, B., Hammack, W. J. Lancet, 1974, ii, 649. 3. Chervenick, P. A., Lo Buglio, A. F. Science, 1972, 178, 164. 4. Pike, B. L., Robinson, W. A. J. Cell. Physiol. 1970, 76, 77. 1.
Fig. 2-Scanning electron micrograph of hybrid cell of L.R.E.