The clinical and haematological features of 15 patients with a rare variant of chronic 1 ymphocytic leukaemia (CLL) are described. The disease predominantly affects males in the sixth and seventh decades of life and presenting symptoms include fatigue, weakness, weight loss, sweats and fevers. Massive enlargement of thc spleen (mean weight at autopsy 1383 g, range 227-3500 g) and to a lesser extent of the liver (mean weight 2445 g, range 2030-307g g) are regular findings. In contrast, peripheral lymphadenopathy is inconspicuous or absent. The characteristic cell in the peripheral blood is a relatively large lymphoid cell w i t h a large vesicular nucleolus, relatively well-condensed nuclear chromatin and moderate amount of cytoplasm. The counts of these cells in the peripheral blood at the time of diagnosis are very high (mean 355 ooo/~l, range 26 000-1 I I O w/~l). The clinical response to methods of treatment that are usually effective in classical CLL (particularly alkylating agents and corticosteroid drugs) is uniformly poor and the patients' survival after diagnosis is in most cases quite short.We believe that the clinical and haematological features of this condition justify its recognition separately from classical CLL, from lymphosarcoma cell leukaemia and from acute lymphoblastic leukaemia. We have therefore designated it 'prolymphocytic leukaemia'. On the basis of a single case we suggest that further trials of splenectomy are indicated.Since 1956 we have encountered 15 patients suffering from a type of lymphocytic leukaemia with several characteristics that distinguish it from classical chronic lymphocytic leukaeniia (CLL). The patients were referred to us as cases of acute lymphoblastic leukaemia, CLL, or in one case as myeloblastic leukaemia. The distinction from lymphoblastic leukaemia and from CLL w a s originally made on the basis of the peculiar morphology of the lymphocytes as seen in Romanowsky-stained fiims of peripheral blood and bone marrow. Later it became apparent that in addition to the lymphocyte morphology these patients all had certain other features in common. In general the presenting symptoms were of short duration, the principal physical signs were gross splenic and slight to gross hepatic enlargement with little or no enlargement of lymph nodes, the absolute lymphocyte counts in the peripheral blood were G.J.G. is now Associate Professor

The tyrosine kinase inhibitor STI571 (imatinib mesylate, Gleevec) is an effective treatment for chronic myeloid leukemia (CML). We examined bone marrow samples from 53 patients with CML who were receiving STI571 in 3 multicenter phase 2 trials to assess morphologic changes and cytogenetic response to this drug. In most patients with initially increased blasts, the bone marrow blast count rapidly decreased during STI571 therapy. Reductions in cellularity, the myeloid/erythroid ratio (commonly with relative erythroid hyperplasia), and reticulin fibrosis (if present pretreatment) also were seen in most patients, resulting in an appearance resembling normal marrow in many cases. Eighteen patients (34%) had some degree of cytogenetic response. Surprisingly, these striking morphologic changes occurred irrespective of any cytogenetic response to STI571. Thus, STI571 seems to affect the differentiation of CML cells in vivo, causing even extensively Philadelphia chromosome-positive hematopoiesis to exhibitfeatures resembling normal hematopoiesis.

Antiacetylcholine receptor antibody (anti-AChR) was spontaneously synthesized by cultured thymic tissue from 19 of 35 patients with myasthenia gravis. Two other thymus cultures produced antibody after stimulation by pokeweed mitogen. Antibody production correlated with histologic evidence of thymitis, long duration of symptoms, or high serum anti-AChR values. None of seven thymomas synthesized antibody in culture, but evidence suggested that there had been in vivo synthesis or trapping of anti-AChR. Clinical improvement after thymectomy, during the short period of study, did not correlate with synthesis rates of anti-AChR production by the removed thymus. The rates of anti-AChR production in culture were too low to suggest that the thymus is the major source of this antibody. Although we did not find a clear relationship between anti-AChR antibody and clinical state within 3 months of thymectomy, in a study of 25 nonimmunosuppressed, nonthymoma patients followed for 1 to 4 years, we found a significant correlation (p less than 0.05, Spearman Rank correlation) between fall in anti-AChR antibody and clinical improvement after thymectomy (unpublished observations).

Background and Purpose. There is limited research on the effects of the number of exercises a person is told to perform on compliance and performance, as defined by cueing requirements, correct alignment, and quality of movement. Some studies of medication suggest that compliance decreases as the number of medications increases. The purpose of this study was to determine whether older adults comply and perform better (ie, requiring less cueing, exhibiting correct alignment, and exhibiting controlled, coordinated, and continuous movements) when they are asked to do 2, 5, or 8 exercises. Subjects. Subjects were 11 women and 4 men, aged 67 to 82 years (X̄=72.8), who were living independently in their communities. Methods. Subjects were randomly prescribed 2, 5, or 8 general strengthening home exercises. They were instructed on their exercises at an initial session and asked to record the number of repetitions performed each day in a self-report exercise log. At a return session 7 to 10 days later, subjects were scored on their performance of the prescribed exercises using a newly designed assessment tool. Results. The group that was prescribed 2 exercises performed better, as defined by their performance tool score, than the group that was prescribed 8 exercises. The group that was prescribed 5 exercises was not different from the groups that performed 2 or 8 exercises. No differences were found among groups regarding the self-report measurement of compliance. There was a moderate correlation between performance scores and the self-report percentage rates. Conclusion and Discussion. Subjects who were prescribed 2 exercises performed better than subjects who were prescribed 8 exercises. The question of an optimal number of exercises to prescribe to elderly people warrants further study.

Vimentin: an evaluation of its role as a tumour marker In this study we examined 198 sarcomas, 38 carcinomas, 13 'tumours with a spindle cell component' and 22 malignant melanomas with a commercial monoclonal virnentin antibody. All histopathological material was formalin fixed and paraffin embedded. The results show this antibody to be a sensitive and specific marker of mesenchymal derivation or differentiation. It is a useful tool in separating sarcomas from most carcinomas, and in separating malignant melanomas from carcinomas. When used in combination with a cytokeratin antibody it identifies carcinosarcomas and synovial sarcomas.