Treatment of hypothyroidism

A series of 77 gallium-67 citrate (67Ga citrate) scans of the abdomen revealed lymphoma in 12 cases (nine of non-Hodgkin's lymphoma, three of Hodgkin's disease). Scanning was undertaken (i) to confirm the suspicion of lymphoma, or (ii) as part of a staging procedure when the diagnosis of lymphoma had been established, or (iii) as a follow-up investigation after treatment of lymphoma. The diagnosis of lymphoma in the upper part of the abdomen is difficult with conventional techniques such as lymphography, and it is in this area that 67Ga citrate scanning is shown to be of value.     

Computed tomography, ultrasound and lymphography in the diagnosis of malignant lymphoma

Lymphographic findings were compared with the results at histopathology in 42 laparotomized patients with malignant lymphoma. Of 12 patients with lymphographically suggested lesions in normal-sized lymph nodes, only one had pathologic changes at histologic examination. Computed tomography gave a better idea of the extent of the disease than lymphography. Moreover, CT had an equal diagnostic accuracy as lymphography for demonstrating enlarged para-aortic lymph nodes. CT should therefore be able to replace lymphography in examination of malignant lymphoma. Ultrasound had the same diagnostic accuracy as CT regarding the upper and middle abdomen but not in the lower abdomen. Ultrasound is of special value in thin patients and when guided needle biopsy is required.     

The importance of the results of pretreatment pelvic lymphographies in the prognosis of carcinomas of the uterine cervix. A critical evaluation of the proposal to classify these tumors according to the TNM system (author's transl)

Between 1966 and 1969, 494 patients with carcinoma of the uterine cervix stages I a to IV were admitted in our hospital for primary treatment. In 420 of these patients with carcinoma of the cervix stage I b to IV, complete results of bilateral pretreatment pelvic lymphography are available. The correlation between the results of the lymphographies, the choice of the operative treatment and the cure rates in these 420 cases are reported. All the correlations between the results of the pretreatment lymphography and the prognosis are described. A positive lymphography was in our series of high prognostic value. A plea is therefore made to include the results of the pretreatment lymphography into the classification of carcinoma of the cervix. Classification of the carcinoma of the cervix into the TNM categories is desirable. Our series is reported in these TNM categories. The advantages of such classification are described. The morbid entity of carcinoma of the cervix becomes more transparent to the observer and the choice of operative therapy becomes easier. The prognosis is more clearly established. The proposals of the TNM committee of the UICC for the classification of carcinoma of the cervix according to the TNM categories and the staging according to these categories are discussed critically.     

全身扩散加权成像在恶性淋巴瘤诊断与疗效评估中的价值

Objective:The aim was to evaluate the role of whole body diffusion weighted imaging (WB-DWI) of magnetic resonance in the diagnosis and efficacy evaluation of malignant lymphoma.Methods: The clinical manifestation of whole body diffusion weighted imaging of 47 patients with malignant lymphoma being pathologically proved were carried on by retrospective analysis and to compare with 10 healthy volunteers.There were 8 cases of Hodgkin's lymphoma (HD) patients, of which WB-DWI examination of 5 cases were carried out before and after treatment and 3 cases were done after treatment.There were 39 cases of non-Hodgkin's lymphoma (NHL) patients, of which WB-DWI examination in 19 cases were acted before treatment, 11 cases were done before and after treatment and 9 cases done after treatment.In apparent diffusion coefficient (ADC) diagram the ADC values of lymph nodes in patients with malignant lymphoma and healthy volunteers were measured respectively, among 16 patients the ADC values of parts of lymph node being consistent with the initial inspection were determined again and compared the values before and after, and compared with healthy volunteers.Results: Whole body magnetic resonance diffusion weighted imaging (MR-DWI) showed more sensitive to lymphoma, and 372 lymph nodes greater than 1 cm were detected with MR-DWI.Before treatment, mean ADC value of 35 patients with malignant lymphoma was (0.86 0.21) × 10-3 mm2/s, of which an average ADC values of 28 cases after treatment was (1.22 0.31)× 10-3 mm2/s, before and after treatment difference of the average ADC values of patients was statistically significant (P < 0.05); the average ADC value of cervical lymph nodes of 10 healthy volunteers (1.29 0.12) × 10-3mm2/s and of 30 patients with malignant lymphoma before treatment was statistically significant (P < 0.05), and to compare with 28 patients after treatment difference of the ADC values was not statistically significant (P > 0.05).Conclusion: WB-DWI and ADC values being measured in the clinical diagnosis of malignant lymphoma, staging and evaluation of efficacy of monitoring is a fast and effective technology, with some clinical value.     

Prevalence of coronary heart disease risk factors in active children, 7 to 12 years of age

Approximately 50% of the hind legs of cats infected with Brugia malayi and insulted with a beta haemolytic streptococcus became elephantoid in appearance after four to six weeks. This condition was found to be reversible. Collateral lymphatic vessels were seen by lymphography in most of the Brugia-streptococcus-infected legs. The popliteal draining systems in two of three cats, which harboured no worms, appeared normal by lymphography at 18 weeks.     

Accuracy of endoscopic ultrasonography in the diagnosis and staging of gastric cancer and lymphoma

BACKGROUND: There is a need to assess the sensitivity, specificity, and predictive value of endoscopic ultrasonography (EUS) in the diagnosis and staging of gastric cancer and lymphoma. METHODS: A prospective study was performed on 86 patients with endoscopic gross appearance suspicious for cancer or lymphoma. Biopsies with endoscopic forceps were always carried out before EUS. All patients underwent laparotomy for final diagnosis, staging, and eventually treatment. The results of EUS were correlated with the histologic findings of the resected specimens, when possible, or with the surgical findings. There were 42 gastric cancers and 44 primary gastric lymphomas. RESULTS: EUS made a correct diagnosis of cancer in 35 of 42 patients, with a sensitivity of 83%. Positive predictability was 87%, specificity was 97%, and negative predictability was 96%. Diagnostic accuracy was 95%. In the evaluation of cancer depth invasion, EUS was correct in 91% of cases. EUS displayed perigastric metastatic lymph nodes in 14 of 25 patients, with a sensitivity of 56%. Positive predictive value was 93%, specificity was 93%, and negative predictive value was 54%. Diagnostic accuracy was 69%. EUS made a correct diagnosis of lymphoma in 39 of 44 patients, with a sensitivity of 89%. Positive predictability was 87%, specificity was 97%, and negative predictability was 97%. Diagnostic accuracy was 95%. In the evaluation of lymphoma depth invasion, EUS was correct in 92% of cases. EUS displayed metastatic perigastric lymph nodes in 8 of 18 patients, with a sensitivity of 44%. Positive predictability was 100%, specificity was 100%, and negative predictability was 72%. Diagnostic accuracy was 77%. CONCLUSIONS: From these data it appears that in these diseases EUS has demonstrated specific ultrasonographic features that allow correct diagnosis and staging in the majority of patients. In difficult cases EUS may help to achieve the correct diagnosis. EUS also appear to be a useful tool for staging of gastric cancer and lymphoma. It shows not only tumor depth and local spread but also the passage from a pathologic to a normal wall and lymph node metastasis. With this accurate noninvasive staging procedure, in the near future many patients will no longer undergo exploratory laparotomy for surgical staging. Thanks to EUS, the choice of conservative or surgical treatment can be strongly affected. In case of surgery, EUS can orient the kind of surgical approach. Moreover, the use of EUS for evaluation of therapy during follow-up will probably become of major importance.     

Comparison of intensive versus moderate chemotherapy of lymphocytic lymphomas: a progress report

In an Easter Cooperative Oncology Group trial, Cytoxan-prednisone (CP) Induction was compared to BCNU-prednisone (BP) in 273 patients with lymphocytic lymphoma. Response rates were comparable, with 21% achieving complete response and 40%, partial response. Patients with a nodular pattern responded better. Maintenance phase comparing cyclic intensive therapy (BCVP) with intermittent chlorambucil revealed the superiority of BCVP as demonstrated by improvement of the quality of response and somewhat longer remissions. The value of the Rappaport classification in the evaluation of lymphoma chemotherapy results is discussed. It is suggested tha NHL be separated into "favorable" and "unfavorable" groups, based on the presence or absence of nodularity and treatment schedules devised accordingly.     

Lymphographic evaluation of 250 patients with malignant melanoma

Foot lymphography was performed in a selected group of 250 patients with malignant melanoma, with different sites of origin and of various stages. The overall incidence of metastases was 40%. The case material was evaluated in detail; the tumors of the inferior limb and those on different sites, e.g., vulva and abdomen, were considered separately. In the group of 188 patients with melanoma of the inferior limb, the incidence of metastases was 42%. In 51%, histologic confirmation was obtained. In the group of 62 patients with melanoma of different sites of the body, the incidence of metastases was 34% and histologic confirmation was obtained in 21 patients. The values of accuracy, sensitivity, and specificity based on the histologic confirmation of the lymphographic reports ranged from 88% to 96%. These data justify the use of lymphography in the initial diagnostic work-up and in the follow-up of these patients.     

Surgical treatment of penile cancer: a follow-up report

One hundred and fifteen patients with penile cancer were treated at Roswell Park Memorial Institute from 1952 to 1975. A full follow-up is reported and factors involving the prognosis are analyzed. Although the clinical error of staging was near 30%, the lymphography results suggest that this study may result in added improvement in preoperative staging. Early diagnosis, adequate surgical resection, and lymph node dissection will improve the survival significantly. When dealing with an individual patient the prognosis is poor when any one or more of the follow factors are present: the lesion involves the shaft; there is a positive margin at the surgical resection; total penectomy is necessary to obtain tumor-free margin; lymphography is positive for tumor involvement of lymph nodes; lymph node dissection has not been performed; positive lymph nodes are found on surgical exploration. The good prognostic factors include: a lesion confined to the glans and partial penectomy is sufficient to obtain a tumor-free margin of resection; no clinical evidence (including lymphography) of lymph node invovlement; performance of lymph node dissection. The histological grading of the tumor should not influence the clinical decision for treatment in our opinion at this time, based on our current results. Further prospective studies of different factors involved in etiology, diagnosis, and treatment of penile cancer are suggested.     

Frequency and significance of anemia in non-Hodgkin's lymphoma patients

OBJECTIVES: Retrospective evaluation of anemia frequency and its prognostic value in patients with different subtypes of non-Hodgkin's lymphoma and comparison with other clinical characteristics. PATIENTS AND METHODS: Anemia was defined as a hemoglobin value less than or equal to 12 g/dl for all men and women over 50 years of age, and less than or equal to 11 g/dl for women under 50 years of age. The study included 1077 adult lymphoma patients treated between 1980 and 1995 with the following histologic subtypes: 127 patients with small lymphocytic or lymphoplasmacytoid, 62 with marginal zone, 50 with mantle-cell, 208 with follicular, 104 with T-cell lymphoma, 426 with diffuse large-cell and, finally, 73 patients with other high-grade lymphomas. RESULTS: Anemia was present in 341 patients (32%). It was an adverse prognostic factor (P < 0.0001) for overall survival (OS) and progression-free survival (PFS) but not for relapse-free survival (RFS). When patients with and those without bone marrow involvement were considered separately, anemia remained an adverse factor. Anemia was significantly associated with shorter PFS in small lymphocytic or lymphoplasmacytoid, mantle cell, diffuse large cell and high-grade lymphomas and with shorter OS in all histologic subgroups except marginal zone lymphoma. In multivariate analysis, anemia was a significant prognostic factor for OS and PFS for the population as a whole (P = 0.0001 and P = 0.0048, respectively) and in patients with bone marrow involvement (P = 0.007 and P = 0.005, respectively) but not in patients without bone marrow involvement. Finally, the addition of anemia to the International Prognostic Index led to an improvement for OS (P = 0.0004) and PFS (P = 0.0004). CONCLUSIONS: Anemia is an important adverse prognostic factor for the outcome of lymphoma patients, particularly in some histologic subgroups and in patients with bone marrow involvement.     

Right axillary lymph node visualization by bipedal lymphography: a case report

In the course of bipedal lymphography, the right axillary nodes were filled with contrast medium from the right pelvic region via the subcutaneous lymphatics. This was verified in the absence of lymphatic obstruction or abnormal corollary lymphatic routes.     

Percutaneous computed tomography lymphography in the rabbit by subcutaneously injected nanoparticulates

RATIONALE AND OBJECTIVES: Surgical lymphangiography is infrequently used in staging cancer because of its inherent limitations. Radiopaque nanoparticulates target lymph nodes draining interstitial tissues and could make percutaneous lymphography feasible. METHODS: Experimental nanoparticulate contrast agent formulations were injected subcutaneously in the forepaw or hindpaw of normal rabbits or rabbits with induced reactive nodal hyperplasia. Axillary and popliteal nodes were imaged with thin-section computed tomography (CT) using quantitative methods to measure node enhancement. Dose-response (0.1-2.0 ml) and time course (4 hr to 10 weeks) of enhancement were assessed. RESULTS: Nodal enhancement above 100 Hounsfield units was consistently obtained. Enhancement was significantly related to dose and peaked at 10 hr with slow washout over the observation period. Nodes with reactive hyperplasia were larger and had heterogeneous enhancement patterns distinctly different from normal nodes. CONCLUSION: Percutaneous CT lymphography effectively depicts the macroscopic intranodal architecture in rabbits.     

Lymphoscintiscanning with colloidal Tc 99m in pediatrics

Lymphatic scintigraphy has proved a useful addition to radiological lymphography in oncological diagnosis in paediatrics. In cases studied comparatively with the two techniques, scintigraphy has been found to offer good resolution capacity also. The radioisotope method demonstrated its greatest value as a control examination for judging results obtained after surgery or radiation. In doubtful cases it was possibile to repeat the examination after a short time in order to evaluate the development of the lymph node lesion. The technique is easy to carry out in paediatric age: 0.5 ml of colloidal Tc with specific activity from 0.3 to 0.5 mCix are injected subcutaneously, mixed with 75 U of hyaluronidase between the Ist and IInd interdigital space to highlight iliac and para-aortic lymph nodes. The useof 99mTc is of special interest because it has made irradiation of these small patients negligible.     

High prevalence and usual persistence of serum monoclonal immunoglobulins evidenced by sensitive methods in renal transplant recipients

BACKGROUND: The occurrence of serum monoclonal immunoglobulins in kidney transplant recipients is well known but their significance and predictive value for the occurrence of lymphoma are a matter of debate. We therefore conducted a study of monoclonal immunoglobulins by a sensitive method during the long-term follow up of grafted patients. METHODS: Monoclonal immunoglobulins were characterized by high-resolution electrophoresis, conventional immunoelectrophoretic analysis, and a sensitive Western blotting procedure in the serum from 84 renal transplant recipients prior to grafting and subsequently, with a 1-8-year follow-up and excluding the patients who developed posttransplant lymphoma. RESULTS: Low abundance monoclonal immunoglobulins were detectable prior to transplantation in 56 cases (66.6%) and after graft in 72 cases (85.5%) (and in 1 case (1.2%) and 18 cases (21.4%) of cases respectively, by immunoelectrophoresis). These abnormalities were often multiple in individual sera. Monoclonal components detected by immunoblotting were transient in 23.8% of patients only (whereas those evidenced by immunoelectrophoresis usually became undetectable by this method) and their pattern was remarkably stable in the majority of cases. The frequency of post-transplant monoclonal immunoglobulins was higher in patients of more than 50 years of age than in younger patients. The appearance of monoclonal components after grafting and their transient character correlated with CMV infections. No correlation was found with various other parameters. The isotypic distribution of monoclonal immunoglobulins with an IgM, IgG3, and IgG1 predominance and an abnormally low kappa/lambda ratio was the same as that observed in various immunodeficiency states. The monoclonal immunoglobulin pattern in three further patients who developed post-transplant lymphoma was unremarkable. CONCLUSION: Monoclonal immunoglobulins hence are not discriminant for lymphoma and their characterization does not appear to be necessary in the evaluation of followed up grafted patients, at least for a prediction of post-transplant lymphoma.     

Plasma thymidine kinase activity in dogs with lymphoma and leukemia

Plasma thymidine kinase (TK) activity was evaluated as a plasma marker for canine lymphoma and leukemia. A tentative "cut-off" value was set at 6.0 U/l as the upper level of plasma TK based on the mean + 2SD of plasma TK activity in 13 clinically healthy dogs. The levels of plasma TK activity in all of the 20 dogs with lymphoma and leukemia were higher than the cut-off value, whereas those in dogs with lymphoma decreased in parallel with the reduction of the tumor mass after chemotherapy. These findings suggested that estimation of plasma TK activity can be used as a plasma marker for lymphoma and leukemia in the dog.     

Symmetric cutaneous necrosis of the hind feet and multicentric follicular lymphoma in a cat

A 7-year-old castrated male domestic shorthair cat was admitted to the veterinary teaching hospital for evaluation of symmetric necrosis of the skin of its hind feet and high liver enzyme activities. Lymphoma was diagnosed on cytologic examination of a fine needle aspirate of the liver. The owner declined treatment for the lymphoma. On postmortem histologic examination, lymphoma was found in the liver, stomach, and multiple lymph nodes. Immunohistochemical staining revealed the neoplasm to have a mixed B- and T-cell follicular arrangement, and a diagnosis of multicentric follicular lymphoma was made. The distal portion of the feet were necrotic, but a neoplastic infiltrate was not seen on histologic examination. After thrombosis and vasculitis were excluded as causes, the ischemic necrosis of the feet of the cat in this report was considered a paraneoplastic syndrome, as can be seen in people with lymphoma or other internal malignancies.     

Indirect computed tomography lymphography of subdiaphragmatic lymph nodes using iodinated nanoparticles in normal dogs

RATIONALE AND OBJECTIVES: We evaluated the imaging characteristics of an iodinated particulate contrast agent for indirect computed tomography (CT) lymphography of normal subdiaphragmatic lymph nodes in dogs. METHODS: Four milliliters of a 15% (wt/vol) iodinated nanoparticle suspension was injected into the gastric, colonic, rectal, or cervical submucosa, loose paraprostatic fascia, or metatarsal subcutaneous tissues in 10 healthy beagles. Endoscopic, CT, or ultrasound guidance was used when necessary to facilitate contrast agent delivery. CT and radiographic images were obtained prior to contrast administration and at 4 hr, 24 hr, and 7 days postcontrast injection. Postmortem examinations were then conducted. RESULTS: CT images showed enhancement of regional lymph nodes draining the various injection sites. The mean attenuation of opacified nodes was 678 +/- 463 Hounsfield units 24 hr after injection and remained elevated 7 days later. Lymph node opacification on CT images correlated well with the node location observed on postmortem examinations. CONCLUSION: Subdiaphragmatic lymph nodes can be effectively opacified using an iodinated nanoparticle contrast agent for indirect CT lymphography.     

Regression of subcutaneous lymphoma following removal of an ovarian granulosatheca cell tumor in a horse

A 9-year-old Arabian mare was admitted for evaluation of multiple subcutaneous nodules and infertility. Fine-needle aspiration of one of the subcutaneous nodules resulted in a cytologic diagnosis of histiolymphocytic lymphoma. Palpation per rectum and transrectal ultrasonography revealed a mass associated with the left ovary. Excision of the ovarian tumor was performed, and a histopathologic diagnosis of granulosa-theca cell tumor was made. After removal of the granulosa-theca cell tumor, subcutaneous nodules regressed. The referring veterinarian reported that the nodules had also disappeared and then recurred after administration of a synthetic progestin. To further characterize the lymphoma and investigate this possible hormonal relationship, immunophenotyping and estrogen and progesterone receptor assays were performed. The subcutaneous lymphoma was classified as a T-cell rich B-cell lymphoma, results of estrogen receptor assays were negative, and results of progesterone receptor assays were positive. Clinical observations of subcutaneous lymphoma in horses indicate that the waxing and waning nature of these tumors may be associated with the estrous cycle, pregnancy, foaling, and lactation. Clinical observations and identification of progesterone receptors suggest that a relationship between serum steroid hormone concentrations, such as estrogen and progesterone, and subcutaneous lymphoma may exists.     

Phlebographic appearances of the left renal and left testicular veins

The normal phlebographic appearances of the left renal and left testicular veins are described, based upon the findings in 100 patients admitted because of confirmed or possible testicular tumor. The patients had no metastases demonstrated at foot lymphography, urography and phlebography of the inferior vena cava.     

Rare case of congenital chyluria

A rare case is presented of congenital chyluria in a 16-year-old boy. On the basis of literature data the pathological mechanism of that disease is discussed. The clinical data and examinations carried out, particularly lymphography, confirmed the preliminary clinical diagnosis.