Diseases of the Blood and Atlas of Hematology

Kracke, Roy R.

doi:10.1097/00007611-194204000-00023

Cited by 2 publications

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“…The question arose whether the brother had died not of monocytic leukaemia but of a myelogenous leu.kaemia, which had been in the monocytic phase at the time of his arrival in hos-p4jal (Kracke and Garver, 1937). The absence of a marked myeloid reaction was regarded as a strong point in the support of the former diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Two Varieties of Leukaemia in One Family

Meikle¹

1944

BMJ

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CHEST COMPLICATIONS AFTER GASTRIC SURGERY MEDICAL JOURNAL is completed. This enables one to avoid heavy or prolonged sedation. Post-operative breathing exercises are restarted the day after operation, and in most cases heavy percussion of the thorax is allowed to be carried out by the masseuse during the first post-operative day. Movements in bed are encouraged, and our patients are rolled for washing purposes during the first post-operative day, unless their condition is unusually poor. Clinical examination of the chest is carried out daily as a routine for the first few post-operative days, for both diagnostic and therapeutic purposes. We believe that the movement and the activity involved in the clinical examination of the chest have a useful therapeutic effect. Coughing is encouraged by all those who deal with the patient. We endeavour to avoid infection in a collapsed lobe by postponing operation in any patient who has an upper respiratory infection or is in any way unfit. We have also been giving 3-g. of sulphathiazole by mouth three hours before operation, followed by 1 g. four-hourly after its completion, for 24 hours. There is no evidence whatever that this measure is of any use, but it seems reasonable to suggest that it may lessen the risk of infection in a lobe which has some stagnant secretion in the air passages.Cuirative Treatment.-Should a pulmonary complication be diagnosed, we rely on frequent breathing exercises and heavy percussion of the chest to assist coughing and expectoration of sputum. We try to keep the patient,as active in bed as possible, as movement often forces an unwilling patient to cough. We have occasionally used suction through a tracheal catheter, both as a prophylactic at the end of operation and as a therapeutic measure, when there appears to be difficulty in coughing. It certainly seems to assist subsequent expectoration. Up to date we have not subjected patients on whom a partial gastrectomy has been performed to bronchoscopy within the first few post-operative days. We have, however, used this for patients who have undergone rather less severe operations, and are prepared to consider it in suitable cases in the future. Discussion One of the great difficulties in discussing post-operative pulmonary complications is to draw a line between what is a complication and what is not. Hypoventilation, as described by Beecher (1933) and others, is probably universal in patients after this operation. Henderson (1935) refers to "collapse without symptoms" as almost a normal sequel to major surgical operations.In this series we x-rayed only those who showed some signs on physical examination. In a second series we are now x-raying every patient as a routine during the first or second post-operative day. It seems likely that in assessing this second series we shall find a rather higher percentage of mild patchy atelectasis, which was almost symptomless but was apparent on a radiograph if looked for. Probably few patients have a post-operative course entirely free from cough and sput...

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Section: Discussionmentioning

confidence: 99%

Two Varieties of Leukaemia in One Family

Meikle¹

1944

BMJ

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Section: Journalmentioning

confidence: 99%

“…Haematologically, therefore, the signs were those of monocytic leukaemia. Reference to the literature, however, indicated that these facts alone were not conclusive' evidence in favour of such a diagnosis.The question arose whether the brother had died not of monocytic leukaemia but of a myelogenous leu.kaemia, which had been in the monocytic phase at the time of his arrival in hos-p4jal (Kracke and Garver, 1937). The absence of a marked myeloid reaction was regarded as a strong point in the support of the former diagnosis.…”

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Superficial Gangrene in Adolescent Diabetes

Whittaker¹

1944

BMJ

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JOURNALLymphocytes, mainly of the small variety, made up the remainder. A hyperchromic type of anaemia affected the red blood cells, the colour index being 1.4. Haematologically, therefore, the signs were those of monocytic leukaemia. Reference to the literature, however, indicated that these facts alone were not conclusive' evidence in favour of such a diagnosis.The question arose whether the brother had died not of monocytic leukaemia but of a myelogenous leu.kaemia, which had been in the monocytic phase at the time of his arrival in hosp4jal (Kracke and Garver, 1937). The absence of a marked myeloid reaction was regarded as a strong point in the support of the former diagnosis.The striking feature of the blood picture in Case II was the presence of a high percentage (92.6) of mononuclear cells, each of which, when stained by Leishman's method, consisted of a round, eccentrically placed nucleus, often containing nucleoli, and blue agranular cytoplasm; many were undergoing division. These cells were considered to be myeloblasts. Only 0.8% of the leucocytes were polymorphonuclear, and the remaining 6.5% were lymphocytes.These findings, together with those in the bone marrow, clearly constituted a blood picture .of myeloblastic leukaemia. Conclusion Two cages of very acute leukaemia, occurring in a brotherand sister living in the same house, are reported. The. sister's illness developed two years after her brother's death.In the brother, a study of blood films strongly suggests the diagnosis of monocytic leukaemia, whereas the sister undoubtedly suffered from acute myeloblastic leukaemia.I am very grateful to-Prof. J. W. McNee for helpful advice and criticism in the preparation of this paper and for permission to publish the second case. To Dr. Forbes Walker, Ayr, I am indebted for the clinical details of the first case.

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Diseases of the Blood and Atlas of Hematology

Cited by 2 publications

References 0 publications

Two Varieties of Leukaemia in One Family

Two Varieties of Leukaemia in One Family

Superficial Gangrene in Adolescent Diabetes

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