786 but
human B cells or by an antiserum leukaemia (A.L.L.) cells which recognise neither T nor B cells (unpublished) (see table). Cross-absorption of two anti-T-cell antisera showed that the blast cells had the same antigenic pattern as peripheral-blood T lymphocytes. Absorption also showed that the blast cells, like blood T cells, lacked antigenic determinants detected on fetal thymocytes by an antiserum to a T-cell lymphoma. Thus, the blast cells displayed many T-cell-specific antigens although they appeared to lack determinants peculiar to very immature stages of the T-cell lineage. Another feature of our case was that the hand-mirror configuration of the blast cells was observed only in the bone marrow (which contained 20% of such cells) and not on the blast cells of lymph-node imprints. Blast cells had the same lymphoblastic appearance on bone-marrow smears and in lymphnode imprints and sections. This suggests that the amoeboid movement might be due to a chemotactic stimulus provided by the surrounding bone marrow. We are now investigating this point. We noticed also that the clinical course of this T lymphoma (in a 7-year-old boy) seemed unusually slow. The first adenomegaly appeared in the cervical region 2 months before the time of diagnosis. A mediastinal mass appeared during the not
by
an
antiserum
to common acute
to
lymphoblastic
workup. Department of Pædiatrics, Institut Gustave-Roussy, 94800 Villejuif, France
A. BERNARD
I.N.S.E.R.M. U 93,
advantage of this tumour regression property of bromocriptine and treated pregnancy-induced tumour growth with bromocriptine with regression of visual-field impairment and taken
normal continuation of the pregnancy. It seems therefore, that bromocriptine may be useful, not only to lower the prolactin to normal (and, therefore, reverse the reproductive dysfunction) but also as an antitumour agent. I now recommend that all my patients who have been on bromocriptine for one year stop this agent; if menses and serum-prolactin remain normal I deduce that tumour size has regressed and I leave them off this agent unless the clinical situation changes. Department of Medicine, University of Calgary, Calgary, Alberta, Canada
B. CORENBLUM
F.F.A., INTESTINAL BYPASS, AND ARTERIAL LIPID ACCUMULATION
SIR,-The very interesting paper by Dr Kral and Dr Bondjers (Aug. 5, p. 288) is disturbing news for those who feel that reduction in body-weight and in blood lipids will lower the risk of death from cardiovascular disease. Kral and Bondjers found that jejunoileal bypass may be associated with an increase in arterial cholesterol despite reduction in both bodyweight and total serum-cholesterol. Is part of the explanation for this related to fat metabolism or is it entirely the result of altered lipoprotein metabolism and the reduced levels of highdensity lipoprotein (H.D.L.) cholesterol reported?
Hôpital Saint Louis, 75010 Paris
L. BOUMSELL
Department of Cytology, Institut Gustave-Roussy
C. BAYLE
Department of Histopathology, Institut Gustave-Roussy
C. MICHEAU
Institut de Recherche en Biologie
Moleculaire, Université Paris VII,
C. PENIT
75221 Paris
P. ROUGET
BROMOCRIPTINE IN PITUITARY TUMOURS
SiR,—The
treatment
of
prolactin-secreting pituitary
is in a state of flux. There are proponents for surgery as the initial attack, but more and more clinicians are advocating primary drug therapy with bromocriptine. Animal data show decrease in tumour size, inhibition of mitotic activity, and even cell necrosis, and there have been some reports of objective regression of tumour size in man. Dr Sobrinho and colleagues (July 29, p. 257) demonstrated a decrease in size of a soft-tissue tumour mass by air-contrast tomography of the sella turcica. In the report of suspected decrease in pituitary tumour size in patients with prolactin-secreting pituitary adenomas treated with bromocriptine’ we noted that visual fields returned to normal. The follow-up of this patient is interesttumours
ing. This 25-year-old woman was found to have a large prolactin-secreting pituitary tumour with bi-temporal hemianopsia, and prolactin levels greater than 3000 ng/ml. Surgery was refused so she was treated with bromocriptine, with regression of the visual fields noted in 1 month and complete return to normal within 6 months. Before bromocriptine pneumoencephalography had demonstrated an intrasellar adenoma with gross suprasellar extension to the level of the optic chiasma. Repeat pneumoencephalography after 6 months of bromocriptine therapy failed to demonstrate any suprasellar extension. Thus to our clinical evidence of a decrease in tumour size we can add objective radiological evidence. Bergh et al. have 1. 2.
Corenblum, B., Webster, B. R., Mortimer, C. B., Ezrin, C. Clin. Res. 1975, 23, 614A. Bergh, T., Nillius, S. J., Wide, L. Br. med. J. 1978, i, 875.
A scheme
which
may be relevant is outlined in the above
figure where intestinal bypass, by reducing body fat, mobilises large amounts of free fatty acid (F.F.A.). Though this can be taken up by peripheral tissues to satisfy energy needs, only the liver is readily able to unload accumulated F.F.A. back into the circulation in water-soluble form. This is achieved in the fasting state by ketone-body synthesis. F.F.A. taken up, but not utilised in peripheral tissues, must be stored and, in the absence of glucose, this may be as cholesterol rather than triglyceride. The large amounts of F.F.A. mobilised during weight loss cause lipid accumulation in the liver,’ despite its ability to handle this substrate, and fatty degeneration of cardiac muscle has been found in the obese after "crash" dietary pro-
grammes.2 It may, therefore, be the raised F.F.A. levels and perhaps decreased levels of the fatty-acid binding protein, serum albumin, which are important factors in arterial cholesterol accumulation in intestinal bypass. In support of this, raised F.F.A. levels have been found in patients with electrocardiographic evidence of ischtmic heart-disease.3’ 1. Lancet, 1976, ii, 666. 2. Garnett, E. S., Barnard, D.
L., Ford, J., Goodbody, R. A., Woodhouse, M.A. ibid 1969, i, 914. 3. Jenkins, D.J. A., Welborn, T. A., Goff, D. V. ibid. 1970, i, 865.
,
human B cells or by an antiserum leukaemia (A.L.L.) cells which recognise neither T nor B cells (unpublished) (see table). Cross-absorption of two anti-T-cell antisera showed that the blast cells had the same antigenic pattern as peripheral-blood T lymphocytes. Absorption also showed that the blast cells, like blood T cells, lacked antigenic determinants detected on fetal thymocytes by an antiserum to a T-cell lymphoma. Thus, the blast cells displayed many T-cell-specific antigens although they appeared to lack determinants peculiar to very immature stages of the T-cell lineage. Another feature of our case was that the hand-mirror configuration of the blast cells was observed only in the bone marrow (which contained 20% of such cells) and not on the blast cells of lymph-node imprints. Blast cells had the same lymphoblastic appearance on bone-marrow smears and in lymphnode imprints and sections. This suggests that the amoeboid movement might be due to a chemotactic stimulus provided by the surrounding bone marrow. We are now investigating this point. We noticed also that the clinical course of this T lymphoma (in a 7-year-old boy) seemed unusually slow. The first adenomegaly appeared in the cervical region 2 months before the time of diagnosis. A mediastinal mass appeared during the not
by
an
antiserum
to common acute
to
lymphoblastic
workup. Department of Pædiatrics, Institut Gustave-Roussy, 94800 Villejuif, France
A. BERNARD
I.N.S.E.R.M. U 93,
advantage of this tumour regression property of bromocriptine and treated pregnancy-induced tumour growth with bromocriptine with regression of visual-field impairment and taken
normal continuation of the pregnancy. It seems therefore, that bromocriptine may be useful, not only to lower the prolactin to normal (and, therefore, reverse the reproductive dysfunction) but also as an antitumour agent. I now recommend that all my patients who have been on bromocriptine for one year stop this agent; if menses and serum-prolactin remain normal I deduce that tumour size has regressed and I leave them off this agent unless the clinical situation changes. Department of Medicine, University of Calgary, Calgary, Alberta, Canada
B. CORENBLUM
F.F.A., INTESTINAL BYPASS, AND ARTERIAL LIPID ACCUMULATION
SIR,-The very interesting paper by Dr Kral and Dr Bondjers (Aug. 5, p. 288) is disturbing news for those who feel that reduction in body-weight and in blood lipids will lower the risk of death from cardiovascular disease. Kral and Bondjers found that jejunoileal bypass may be associated with an increase in arterial cholesterol despite reduction in both bodyweight and total serum-cholesterol. Is part of the explanation for this related to fat metabolism or is it entirely the result of altered lipoprotein metabolism and the reduced levels of highdensity lipoprotein (H.D.L.) cholesterol reported?
Hôpital Saint Louis, 75010 Paris
L. BOUMSELL
Department of Cytology, Institut Gustave-Roussy
C. BAYLE
Department of Histopathology, Institut Gustave-Roussy
C. MICHEAU
Institut de Recherche en Biologie
Moleculaire, Université Paris VII,
C. PENIT
75221 Paris
P. ROUGET
BROMOCRIPTINE IN PITUITARY TUMOURS
SiR,—The
treatment
of
prolactin-secreting pituitary
is in a state of flux. There are proponents for surgery as the initial attack, but more and more clinicians are advocating primary drug therapy with bromocriptine. Animal data show decrease in tumour size, inhibition of mitotic activity, and even cell necrosis, and there have been some reports of objective regression of tumour size in man. Dr Sobrinho and colleagues (July 29, p. 257) demonstrated a decrease in size of a soft-tissue tumour mass by air-contrast tomography of the sella turcica. In the report of suspected decrease in pituitary tumour size in patients with prolactin-secreting pituitary adenomas treated with bromocriptine’ we noted that visual fields returned to normal. The follow-up of this patient is interesttumours
ing. This 25-year-old woman was found to have a large prolactin-secreting pituitary tumour with bi-temporal hemianopsia, and prolactin levels greater than 3000 ng/ml. Surgery was refused so she was treated with bromocriptine, with regression of the visual fields noted in 1 month and complete return to normal within 6 months. Before bromocriptine pneumoencephalography had demonstrated an intrasellar adenoma with gross suprasellar extension to the level of the optic chiasma. Repeat pneumoencephalography after 6 months of bromocriptine therapy failed to demonstrate any suprasellar extension. Thus to our clinical evidence of a decrease in tumour size we can add objective radiological evidence. Bergh et al. have 1. 2.
Corenblum, B., Webster, B. R., Mortimer, C. B., Ezrin, C. Clin. Res. 1975, 23, 614A. Bergh, T., Nillius, S. J., Wide, L. Br. med. J. 1978, i, 875.
A scheme
which
may be relevant is outlined in the above
figure where intestinal bypass, by reducing body fat, mobilises large amounts of free fatty acid (F.F.A.). Though this can be taken up by peripheral tissues to satisfy energy needs, only the liver is readily able to unload accumulated F.F.A. back into the circulation in water-soluble form. This is achieved in the fasting state by ketone-body synthesis. F.F.A. taken up, but not utilised in peripheral tissues, must be stored and, in the absence of glucose, this may be as cholesterol rather than triglyceride. The large amounts of F.F.A. mobilised during weight loss cause lipid accumulation in the liver,’ despite its ability to handle this substrate, and fatty degeneration of cardiac muscle has been found in the obese after "crash" dietary pro-
grammes.2 It may, therefore, be the raised F.F.A. levels and perhaps decreased levels of the fatty-acid binding protein, serum albumin, which are important factors in arterial cholesterol accumulation in intestinal bypass. In support of this, raised F.F.A. levels have been found in patients with electrocardiographic evidence of ischtmic heart-disease.3’ 1. Lancet, 1976, ii, 666. 2. Garnett, E. S., Barnard, D.
L., Ford, J., Goodbody, R. A., Woodhouse, M.A. ibid 1969, i, 914. 3. Jenkins, D.J. A., Welborn, T. A., Goff, D. V. ibid. 1970, i, 865.
,
