Clinical analysis of elderly patients with malignant lymphoma

An epidemiological study on 173 consecutive elderly malignant lymphoma patients age 65 years or over was performed and the clinical outcome of chemotherapy is reported. Of there, 131 patients (75.7%) had non-Hodgkin's lymphoma (NHL) and 21 patients had Hodgkin's disease (HD). As for clinical staging, 58.9% of patients were in stage 3 or 4. The initial sites were nodal in 61.8% of the patients the most common sites of involvement in superficial lymph nodes being cervical, inguinal and axillar. The most frequent site of extranodal involvement was the gastrointestinal tract. The cases were treated with CHOP/COPP, BACOP or COP-BLAM combination chemotherapy. The clinical efficacy of these modalities was similar, with complete remission rates being about 50%. However, the total response rate (CR+partial remission) by the COP-BLAM regimen were 88.1%. The median survival time of cases achieving CR, was longer than 47 months. The most frequent cause of death was infection, especially pneumonia and septicemia. Many elderly ML patients were found and diagnosed when the disease developed to an advanced stage. Therefore it is necessary to make efforts to find early ML patients by screening apparently healthy elderly people. Improvement of the complete remission rate should be obtained if vigorous and intensive chemotherapy is carried out with careful supportive therapy concerning the general condition and complications in patients.     

The use of acupuncture reflexotherapy in treating patients with rheumatoid arthritis

Efficiency was studied of multi-modality treatment of rheumatoid arthritis (RA) involving acupuncture (A). Indices were assessed for the number of the inflamed joints, the joint index, duration of the morning rigidity and visual scale of pain. Combined treatment of RA using A was found to more effectively lower the values for the joint index and visual scale of pain. A conclusion was reached to the effect that A may improve results of drug treatment.     

Delayed positive thallium uptake in large B-cell non-Hodgkin's malignant lymphoma

We report an unusual finding in an AIDS patient who presented with a large mediastinal mass and multiple lymphadenopathy. A sequential thallium and gallium scan to specify the nature of the mediastinal mass was requested. The early thallium images, acquired 15 min after the intravenous injection, showed no uptake in the mass. The delayed images 2 hr later showed intense thallium uptake. A gallium scan performed 48 hr later also showed intense gallium uptake in the mediastinal mass. Biopsy from the inguinal lymph node confirmed the presence of large-cell diffuse noncleaved malignant lymphoma. This case raises questions about the optimum time of imaging for thallium in high-grade lymphoma, whether delayed imaging is essential, about previous reports of low sensitivity of thallium in undifferentiated lymphoma and about the mechanism of thallium uptake in this type of tumor.     

Natural killing activity in patients with spontaneous regression of malignant lymphoma

Previously, we proposed a new analysis of natural killing activity, for comparison, employing an "individual effector/target cell ratio" according to the number of effector cells in blood. The activity could be measured in four patients with spontaneous regression of malignant lymphoma. Despite the absence of episodes suggesting viral infections, patients with spontaneous regression had significantly higher activities prior to their regressions than either controls or patients without regression. In one patient who had a spontaneous regression accompanied by a high level of natural killing activity, subsequent exacerbation of the disease with a reduced activity was never followed by a regression and became life-threatening. In another patient, a spontaneous regression was accelerated after greater augmentation of natural killing activity was induced by a superimposed viral infection. These facts suggest that highly elevated natural killing activity may be one of the possible mechanisms responsible for spontaneous regression of malignant lymphoma.     

The use of pilastin for treating patients with chronic suppurative otitis media

Gas gangrene is caused by multiple species of Chlostridium, generally as a complication of traumatismus producing necrotic infections. This kind of infection is rare and specially uncommon in childhood. A case of post-traumatic Chlostridium perfringens infection is presented in a two year old girl after an open fracture of the hand. In order to reveal the extension of the process different examinations were performed including radiography of the hand, angiography and infrared thermography. These studies are describen and correlated, specially the angiography and the infrared thermography as a non-invasive method, as well as the treatment and evolution.     

The use of transosseous osteosynthesis in treating fractures of the tubular bones]

Comparative analysis was performed of results of the treatment of patients with ischemic stroke, including 140 ones treated by means of hemodilution method (control group) and 40 patients treated with cerebrolysin (test group). Barolin's scale of the neurorehabilitation was used for the analysis of the results. Statistically significant results of rehabilitation were better in the test group. Improvement of the parameters characterizing social contacts, working activity and behaviour was more pronounced than an improvement of motor functions. Cerebrolysin had accelerating effect on restoration of damaged functions, by creating more stable basis for rehabilitation.     

Diabetes insipidus revealing primary malignant non-Hodgkin''s lymphoma of bone]

Renal histology is increasingly used as a guide for therapy and prognosis in SLE but data in children are few and/or short-term. We assessed renal histological features in 19 children with SLE to determine whether these features are useful in predicting long-term outcome. Mean age at biopsy was 10 +/- 1.7 years old, male to female ratio was 1:2.8. Fourteen patients (73%) had diffuse proliferative lupus nephritis. Renal histology was evaluated using an activity index (AI) and chronicity index (CI). Clinical assessment of renal function at biopsy and outcome were graded according to urinalysis and serum creatinine. Renal function at biopsy correlated well with AI (p < 0.001) but not CI. At short-term follow-up (30 months), 3 patients had died from sepsis and another 2 reached end-stage renal disease. CI predicted poor clinical outcome, i.e. death or renal failure (p < 0.005) but AI did not. At long-term follow-up (mean 92.1 +/- 26.8 months) only one more patient reached end-stage renal disease. In others renal function assessment showed improvement or were stable. Neither CI nor AI correlated with clinical outcome. We conclude that although AI correlates well with renal function at biopsy and CI with short-term prognosis, neither can predict long-term outcome. Treatment may have altered the natural course of disease in these patients.     

The MRI of cervical lymph node metastasis with malignant tumor of the head and neck]

Ketamine has many properties that are advantageous to the practitioner in a rural setting, particularly if solo. The personal experience of the author is recounted, and a technique for using ketamine is outlined.     

Use of the international prognostic index and the tumor score to detect poor-risk patients with primary mediastinal large B-cell lymphoma: a study of 37 previously untreated patients

How can enzymes function in the centre of a crowded lens over the many decades of an individual's life when the same proteins are usually turned over in a period of days or h in most other tissues? The discovery that alpha-crystallin could function as a molecular chaperone in-vitro has led to the hypothesis that alpha-crystallin could protect enzyme activities against various stresses. In the laboratory the authors have focused on the effect of alpha-crystallin on the activity of enzymes upon exposure to a chemical or thermal stress. The authors have demonstrated that enzymes are rapidly inactivated by sugars, sugar phosphates, steroids and cyanate. These compounds are elevated in diseases such as diabetes, diarrhoea and renal failure, all of which are risk factors for cataract. alpha-Crystallin has been shown to protect specifically against both chemically- and thermally-induced inactivation. Some enzymes are protected with a stoichiometry of one or two enzyme molecules protected per alpha-crystallin aggregate, consistent with a chaperone-like structure. However with other enzymes a more efficient protection occurs consistent with a micellar structure or binding on the outside of alpha-crystallin molecules. Investigation of complex formation indicates that although stable complex formation between enzymes and alpha-crystallin may be involved in protection of enzymes against thermal inactivation, protection against chemically-induced inactivation may be more dynamic in nature.     

Recombinant alpha2-interferon substances in treating patients with acute hepatitis B with a mild course]

The role of clinical pharmacy in the health care system is changing rapidly. This change is almost universal among different countries and is related to developments in medical technology, health economics, informatics, socio-economic status, and professional relations. Transitions to new systems of clinical pharmacy are difficult to anticipate. Even with well defined targets, it remains uncertain what the future of clinical pharmacy will bring us. The construction of plausible scenarios may help us better in preparing for the 'new world' ahead. At the annual congresses of ESCP in Prague 1995 (24th) and Lisbon 1996 (25th), a number of scenario analysis workshops with respect to the future of clinical pharmacy were organized. This paper gives a report of the results of these scenario sessions and reflects on the implications for future policy making. After we identified the driving forces behind the future of clinical pharmacy, various sets of assumptions were made and from them scenarios were constructed which are plausible: they 'could' happen. This analysis provided a logical framework in which we ultimately depicted three alternating stories of the future of clinical pharmacy, named 'CLERK', 'CONTROLLER' and 'CARE MANAGER'. These scenarios are intended to help clinical pharmacists to break free of familiar mental maps and to stimulate creative thinking on the future.     

P53突变蛋白表达对弥漫大B细胞淋巴瘤预后的预测作用

目的 探讨p53突变蛋白表达对弥漫大B细胞淋巴瘤(DLBCL)预后的预测作用,指导个体化治疗.方法 随机选择初治DLBCL患者62例,应用免疫组织化学方法检测p53突变蛋白和CD10、bcl_6、MUM1的表达,分析p53突变蛋白表达与患者临床特征、分子分型以及预后的关系.结果 48.4%(30/62)的患者表达p53突变蛋白.p53突变蛋白表达与初始治疗反应有关(x2=20.365,P=0.040),阳性组的完全缓解率为33.3%(10/30),阴性组为59.4%(19/21);与分子分型有关(x2=31.023,P=0.021),阳性组非生发中心型比例显著高于阴性组,分别为83.3%和56.2%;与其他临床特征无关.多因素生存分析显示p53突变蛋白表达是独立的预后预测因子,阳性组的无进展生存期和中位生存期均短于阴性组(x2=36.784,P=0.005和x2=35.276,P=0.006).结论 p53突变蛋白表达是DLBCL独立的不良预后因子,能够用来指导个体化治疗.     

ARDS associated with tumor lysis syndrome in a patient with non-Hodgkin''s lymphoma

ARDS developed in association with tumor lysis syndrome (TLS) in a patient with non-Hodgkin's lymphoma. Although a number of life-threatening complications have been noted to occur following TLS, this appears to be the first report of ARDS developing in association with TLS.     

The development of malignant rhabdoid tumor in a patient with Beh?et's disease treated with ciclosporin

PURPOSE: To describe a risk of malignant neoplasm in patients with Beh?et's disease treated with ciclosporin. METHODS: Case report. RESULTS: A patient with Beh?et's disease who was treated with ciclosporin developed a mass in his right femur. Histological examination revealed this mass was a malignant rhabdoid tumor. CONCLUSION: This is the first known case of malignant tumor developing in a patient with Beh?et's disease treated with ciclosporin. This case underscores the importance of assessing possible risks in the treatment of Beh?et's disease with ciclosporin.     

The polymerase chain reaction detects B cell clonalities in patients with Sj?gren's syndrome and suspected malignant lymphoma

OBJECTIVE: To investigate the usefulness of the polymerase chain reaction (PCR) to detect B cell clonal expansions in tissues where lymphoproliferative disease was suspected in the course of Sj?gren's syndrome (SS). METHODS: Tissue samples from 7 patients with definite (5 cases) or probable (2 cases) SS were subjected to routine histopathologic studies, immunophenotyping, and genotypic analysis, including Southern blotting and PCR amplification of immunoglobulin heavy chain (IgH) variable-diversity-joining (VDJ) region gene rearrangements. RESULTS: Malignant lymphoma was detected in 3 cases, and myoepithelial sialadenitis in the remaining 4. B cell clonal expansion was detected in 7/7 cases by PCR, 5/7 by Southern blotting, and in no case of myoepithelial sialadenitis by kappa/lambda light chain immunophenotyping. CONCLUSION: PCR may represent a quick and powerful tool to detect B cell clonalities in SS. Such information may provide new insights into the pathogenesis of the disease and may improve the clinical approach to the patients.     

Serum 5-nucleotidase and alkaline phosphatase in patients with malignant neoplasms]

The biosynthetic abilities of WI-38 fibroblasts from early and late population-doubling-level cultures were compared by autoradiography of cells grown with labeled precursors of DNA, RNA, protein and lipids. Incorporation of radioactive thymidine, uridine, protein-hydrolysate, acetate, oleic acid and cholesterol, as measured by the number of grains per cell surface, decreased with the progressive aging of the culture. However, the decrease in the incorporation of acetate, oleic acid and cholesterol was much smaller than that of the other precursors, indicating that lipid synthesis is affected to a lesser degree than protein and nucleic acid synthesis on aging. This result is in accord with the higher lipid content and proliferation of intracellular membranes in cells of "old" WI-38 cultures reported by others.     

Intravascular malignant lymphoma: report of a case

The authors describe a case of malignant intravascular angiotropic lymphoma presenting an atypical clinical and radiological picture. After postmortem examination, the histologic test performed on various organs showed massive proliferation of mononucleate neoplastic cells inside small and intermediate-sized vessels without involvement of the surrounding parenchyma. The immunohistochemical exams performed permitted the identification of the above-mentioned cells as lymphoid elements belonging to phenotype B. A bilateral papillar renal necrosis was detected. This necrosis, not mentioned by the preceding literature, was, in all probability, caused by alterations of the microcirculation.     

Intraosseous malignant peripheral nerve sheath tumor in a patient with neurofibromatosis

Malignant peripheral nerve sheath tumors (MPNSTs) are uncommon sarcomas that almost always arise in soft tissue. They can develop in pre-existing neurofibromas or schwannomas, de novo from peripheral nerves, or following radiation therapy. Primary intraosseous MPNST is rare and has been reported most frequently in the mandible. Of the reported cases involving the long bones, none has been associated with neurofibromatosis type 1 (NF-1). We report a case of MPNST arising in the femur in a patient with NF-1.