1264 that one might draw from your editorial. On the contrary, the ultimate benefit to the dialysis patient of a strict "no transfusion" policy should not be underestimated. Centre Hospitalier et Universitaire, Service du Traitement de l’Insuffisance Rénale, 34059 Montpellier Cedex, France.
STANLEY SHALDON
T-CELL ORIGIN OF ACID-PHOSPHATASE-POSITIVE LYMPHOBLASTS
SIR,—Dr Catovsky (Aug. 16, p. 327) tells of a strong acidphosphatase reaction in the blast cells of T-lymphoblastic leukaemia. He describes a patchy, characteristically paranuclear reaction, which electron microscopy shows to be confined to the membranes of the Golgi apparatus and neighbouring lysosomes. According to Dr Catovsky, a positive correlation between this pattern of reaction and functional T-cell characteristics can also be found in T-prolymphocytic leukæmia12 and in acute and chronic T-cell leukmmia.1 We have found a comparable acid-phosphatase reaction in two necropsy cases of
mycosis fungoides. In the first case (male, aged 46; mycosis fungoides in the tumour-forming terminal stage) 54% of tumour cells in lymphnode imprints had a coarse granular or patchy acid-
LIVER BIOPSY IN EARLY SYPHILITIC HEPATITIS
SIR,—Having read the paper by Dr Feher and his colleagues (Nov. 8, p.896), I should not wish to be treated for syphilis in Budapest. Investigation by two liver biopsies as part of the management of proven secondary syphilis seems to me entirely against the interests of the patient. I wonder whether each patient was told that a liver biopsy carries a definite mortality and that it could be of no value to him as an individual, I would be interested if our Hungarian colleagues would care to
defend the ethics of their exoerimental work. Logan Place, London W8. J. F. T. ALLISON
10A
*We showed this letter to Dr Fehér and his whose reply follows.-Eo. L.
colleagues,
SIR,-Percutaneous biopsy and histological examination
today have a prominent place in the diagnosis of liver disease.’ The diagnosis, prognosis, and treatment can be judged more or less exactly only with the help of morphological examinations. The complication-rate in a combined series of punch biopsies collected from many centres is low. In 79 381 biopsies the mortality-rate was 0.015% and serious complications arose in 0.34%.2 The risks from liver biopsy increase with the calibre of the cannula.3 Fine-needle aspiration biopsy is less dan-
gerous.4 Fine-needle biopsy was performed in our syphilitic patients hepatomegaly if at least three of the tests (S.G.O.T.,
with
S.G.P.T., L.D.H., B.S.P., colloid
lability, serum-bilirubin level, prothrombin-time, y-globulin concentration) were abnormal. A history of hr-moffhagic diathesis was taken as a contraindication to biopsy. The second biopsy, after penicillin treatment, was necessary to control further therapy. Before the biopsy all patients were told about the method, the dangers, and the influence of the result on treatment. 3rd Department of Medicine, Semmelweis Medical University,
J. FEHÉR
1st Department of Dermatology, Kállai Eva Hospital,
T. SOMOGYI MARGIT TIMMER
Department of Pathology, National Institute
of Traumatology, Budapest, Hungary.
Acid-phosphatan reaction in cells of a lymph-node imprint. Mycosis fungoides, tumour-formino terminal state.
phosphatase reaction in a defined paranuclear area (see accompanying figure), 21% showed a diffuse coarse granular reaction, and 18% a diffuse fine granular reaction; 7% were negative. In the second case (male, aged 75; mycosis fungoides in the terminal
stage with immunoblastic sarcoma and leukzmic blood-
picture4), 31% of tumour cells in lymph-node imprints had a strictly paranuclear acid-phosphatase reaction. In analogy to the observations of Dr Catovsky and his colleagues, these findings could support the view that mycosis fungoides is a T-cell lymphoma. Other studies’-’ have provided evidence of this. Department of Pathology, University of Kiel, D-2300 Kiel, West Germany.
E.-W. SCHWARZE
1.
Catovsky, D., Galetto, J., Okos, A., Miliani, E., Galton, D. A. G. J. clin. Path. 1974, 27, 767. 2. Catovsky, D., Frisch, B., Van Noorden, S. Blood Cells, 1975, 1, 115. 3. Flandrin, G., Brouet, J. C., Seligmann, M. Edited by Catovsky, D. Lancet, Aug. 16, 1975, p. 327. Schwarze, E. W., Ude, P. Virchows Arch. A., 1975, 368 (in the press). Edelson, R. L., Kirkpatrick, C. H., Shevach, E. M., Schein, P. S., Smith, R. W., Green, I., Lutzner, M. Ann. intern. Med. 1974, 80, 685. 6. Rabinowitz, B. N., Noguchi, S., Roenigk, Jr., H. H. Paper (no. 5), Joint
Derm. 1975, 65, 367.
JOZSA
ALLERGY IN THE GASTROINTESTINAL TRACT SIR,— i nc resuns oi amuungai merapy given to pauems III area who have chronic diarrhoea one month or
this
(duration more) and positive Candida albicans cultures from their faeces have been good. Many clinicians, notably paediatricians, have observed this and are convinced. Your editorial (Nov. 22, p. 1021) should have emphasised that C. albicans can cause allergic reactions in the large bowel. There is no doubt that it causes allergic reactions in the buccal and the anal mucous membranes, and that the best way to treat C. albicans allergy of the anal mucous membrane and perianal skin is by oral antifungal therapy. The fact that C. albicans can often be isolated from fæcal cultures of symptom-free people is no argument against its causing allergic colonic reactions in occasional susceptible patients. Before readers dismiss this idea as nonsense I suggest that they try treating suitable patients. An account of my work has aooeared elsewhere.’’6 Department of Microbiology, Hull Royal Infirmary, Anlaby Road, Hull HU3 2JZ.
4. 5.
Meeting of Society for Investigative Dermatology and European Society for Dermatological Research, Amsterdam, June 9-13, 1975. 7. van Leeuwen, A. W. I. M., Meijer, C. J. L. M., de Man, J. C. H. J. invest.
L.
1. De Groote, J., et al. Lancet, 1968, ii, 626. 2. Lindner, H. Dt. med. Wschr. 1967, 92, 1751. 3. Menghini, G. New Engl. J. Med. 1970, 283, 582. 4. Lundquist, A. Acta med. scand. 1971, suppl. 520, p.7. 5. Alexander, J. G. Curr. Med. Drugs, 1967, 8, (4), 3. 6. Aleander, J. G. Br. med. J. 1969, ii, 251.
J. G. ALEXANDER
STANLEY SHALDON
T-CELL ORIGIN OF ACID-PHOSPHATASE-POSITIVE LYMPHOBLASTS
SIR,—Dr Catovsky (Aug. 16, p. 327) tells of a strong acidphosphatase reaction in the blast cells of T-lymphoblastic leukaemia. He describes a patchy, characteristically paranuclear reaction, which electron microscopy shows to be confined to the membranes of the Golgi apparatus and neighbouring lysosomes. According to Dr Catovsky, a positive correlation between this pattern of reaction and functional T-cell characteristics can also be found in T-prolymphocytic leukæmia12 and in acute and chronic T-cell leukmmia.1 We have found a comparable acid-phosphatase reaction in two necropsy cases of
mycosis fungoides. In the first case (male, aged 46; mycosis fungoides in the tumour-forming terminal stage) 54% of tumour cells in lymphnode imprints had a coarse granular or patchy acid-
LIVER BIOPSY IN EARLY SYPHILITIC HEPATITIS
SIR,—Having read the paper by Dr Feher and his colleagues (Nov. 8, p.896), I should not wish to be treated for syphilis in Budapest. Investigation by two liver biopsies as part of the management of proven secondary syphilis seems to me entirely against the interests of the patient. I wonder whether each patient was told that a liver biopsy carries a definite mortality and that it could be of no value to him as an individual, I would be interested if our Hungarian colleagues would care to
defend the ethics of their exoerimental work. Logan Place, London W8. J. F. T. ALLISON
10A
*We showed this letter to Dr Fehér and his whose reply follows.-Eo. L.
colleagues,
SIR,-Percutaneous biopsy and histological examination
today have a prominent place in the diagnosis of liver disease.’ The diagnosis, prognosis, and treatment can be judged more or less exactly only with the help of morphological examinations. The complication-rate in a combined series of punch biopsies collected from many centres is low. In 79 381 biopsies the mortality-rate was 0.015% and serious complications arose in 0.34%.2 The risks from liver biopsy increase with the calibre of the cannula.3 Fine-needle aspiration biopsy is less dan-
gerous.4 Fine-needle biopsy was performed in our syphilitic patients hepatomegaly if at least three of the tests (S.G.O.T.,
with
S.G.P.T., L.D.H., B.S.P., colloid
lability, serum-bilirubin level, prothrombin-time, y-globulin concentration) were abnormal. A history of hr-moffhagic diathesis was taken as a contraindication to biopsy. The second biopsy, after penicillin treatment, was necessary to control further therapy. Before the biopsy all patients were told about the method, the dangers, and the influence of the result on treatment. 3rd Department of Medicine, Semmelweis Medical University,
J. FEHÉR
1st Department of Dermatology, Kállai Eva Hospital,
T. SOMOGYI MARGIT TIMMER
Department of Pathology, National Institute
of Traumatology, Budapest, Hungary.
Acid-phosphatan reaction in cells of a lymph-node imprint. Mycosis fungoides, tumour-formino terminal state.
phosphatase reaction in a defined paranuclear area (see accompanying figure), 21% showed a diffuse coarse granular reaction, and 18% a diffuse fine granular reaction; 7% were negative. In the second case (male, aged 75; mycosis fungoides in the terminal
stage with immunoblastic sarcoma and leukzmic blood-
picture4), 31% of tumour cells in lymph-node imprints had a strictly paranuclear acid-phosphatase reaction. In analogy to the observations of Dr Catovsky and his colleagues, these findings could support the view that mycosis fungoides is a T-cell lymphoma. Other studies’-’ have provided evidence of this. Department of Pathology, University of Kiel, D-2300 Kiel, West Germany.
E.-W. SCHWARZE
1.
Catovsky, D., Galetto, J., Okos, A., Miliani, E., Galton, D. A. G. J. clin. Path. 1974, 27, 767. 2. Catovsky, D., Frisch, B., Van Noorden, S. Blood Cells, 1975, 1, 115. 3. Flandrin, G., Brouet, J. C., Seligmann, M. Edited by Catovsky, D. Lancet, Aug. 16, 1975, p. 327. Schwarze, E. W., Ude, P. Virchows Arch. A., 1975, 368 (in the press). Edelson, R. L., Kirkpatrick, C. H., Shevach, E. M., Schein, P. S., Smith, R. W., Green, I., Lutzner, M. Ann. intern. Med. 1974, 80, 685. 6. Rabinowitz, B. N., Noguchi, S., Roenigk, Jr., H. H. Paper (no. 5), Joint
Derm. 1975, 65, 367.
JOZSA
ALLERGY IN THE GASTROINTESTINAL TRACT SIR,— i nc resuns oi amuungai merapy given to pauems III area who have chronic diarrhoea one month or
this
(duration more) and positive Candida albicans cultures from their faeces have been good. Many clinicians, notably paediatricians, have observed this and are convinced. Your editorial (Nov. 22, p. 1021) should have emphasised that C. albicans can cause allergic reactions in the large bowel. There is no doubt that it causes allergic reactions in the buccal and the anal mucous membranes, and that the best way to treat C. albicans allergy of the anal mucous membrane and perianal skin is by oral antifungal therapy. The fact that C. albicans can often be isolated from fæcal cultures of symptom-free people is no argument against its causing allergic colonic reactions in occasional susceptible patients. Before readers dismiss this idea as nonsense I suggest that they try treating suitable patients. An account of my work has aooeared elsewhere.’’6 Department of Microbiology, Hull Royal Infirmary, Anlaby Road, Hull HU3 2JZ.
4. 5.
Meeting of Society for Investigative Dermatology and European Society for Dermatological Research, Amsterdam, June 9-13, 1975. 7. van Leeuwen, A. W. I. M., Meijer, C. J. L. M., de Man, J. C. H. J. invest.
L.
1. De Groote, J., et al. Lancet, 1968, ii, 626. 2. Lindner, H. Dt. med. Wschr. 1967, 92, 1751. 3. Menghini, G. New Engl. J. Med. 1970, 283, 582. 4. Lundquist, A. Acta med. scand. 1971, suppl. 520, p.7. 5. Alexander, J. G. Curr. Med. Drugs, 1967, 8, (4), 3. 6. Aleander, J. G. Br. med. J. 1969, ii, 251.
J. G. ALEXANDER
