Hyperplasia of axillary nodes in patients undergoing immunotherapy

OBJECTIVE: CT scans of the chest in 32 patients undergoing immunotherapy for metastatic renal cell carcinoma were evaluated to determine the incidence and significance of axillary lymph node enlargement during therapy. CONCLUSION: Axillary node enlargement in cancer patients undergoing immunotherapy should not be assumed to be metastatic in origin but may result from the stimulation of the immune system during treatment.     

Scanning electron microscopy of the accessory sex glands of the adult male rat

A systematic, comparative study of the accessory sex glands of the adult male rat after androgen withdrawal was carried out. The changes were investigated by using scanning electron microscopy at different intervals after surgical castration. The main common signs of epithelial cell involution were flattening of the cell surface, reduction of the size and number of microvilli, some blurring of the cell borders, cessation of secretory activity and diminution of the luminal volume of the glands. Overall, confident signs of atrophy were evident after one week, and complete epithelial involution was reached by the third week. The epithelial cell atrophy was accompanied by a relative stromal hyperplasia. The new observation seems to be that the process of stroma consolidation is progressing for a considerable time subsequent to the completion of the epithelial involution. This phenomenon is particularly evident in the dorsal prostate, the seminal vesicle and the coagulating gland.     

Spatial organization of microtubules and microfilaments in larval and adult salivary glands of Drosophila melanogaster

We examined the distribution of microtubules and microfilaments by conventional fluorescence microscopy and laser scanning confocal microscopy in larval and adult salivary glands of Drosophila melanogaster. The cells of the larval salivary gland epithelium were characterized by the same spatial distribution of microfilaments, whereas microfilament localization was more complex in adult salivary glands, showing some regional differentiation. Microtubules distributed throughout the cell cytoplasm of the larval salivary glands, whereas in adult glands they were mostly observed in the basal or apical cytoplasm of the cells. These observations were related to the secretory process and the mechanism of saliva discharge.     

Primary localization amyloidosis of the sublingual gland

We here in present a very rare case of primary localized amyloidosis with amyloid A protein of the sublingual gland. It presented a tumorous appearance on the left oral floor. Pretreatment with potassium premanganate made biopsy specimens unstained by Congo red. Immunohistochemical staining for AA protein was positive. Systemic amyloidosis was ruled out based on clinical and laboratory examinations. The gastric and the labial salivary glands biopsy showed no amyloid deposits. As far as we know, this is the first case of primary localized amyloidosis with amyloid A protein of the oral cavity, and tumor-formed amyloidosis of the sublingual gland.     

Interdisciplinary concepts in treating adult patients

Pre-prosthetics, as a part of orthodontic treatment in adults has gained increasing importance during recent years. Through coordinated orthodontic, prosthetic and periodontal treatment plans, patients with partial dentition can be offered further treatment possibilities. Such planning would allow for fixed prosthetic treatment possibilities and the survival of critical teeth. They would provide for better aesthetics and avoid functional disturbances. The aim of the present study was to present reports of patients treated by coordinated work at the Dental School of Hamburg University. In patients with partial dentition, premolars were uprighted and distally moved and molars were extruded to be used as abutments for fixed prosthetic reconstructions. Following trauma, the position of the remaining anterior teeth was improved to provide for optimal aesthetics after prosthetic treatment. Extraction of a subalveolarly fractured tooth is avoided through root extrusion and post-core reconstruction. The results demonstrate the advantages of pre-prosthetic treatment as regards stability, aesthetics and function. With the help of pre-prosthetic orthodontic treatment, complicated treatment situations could be handled more successfully than would have been the case without such treatment.     

Reduced sialylation of glycoproteins in nasal glands of patients with chronic sinusitis

This study was conducted to investigate the sialylations of glycoproteins in the nasal glands of patients with chronic sinusitis. Sialic acids were detected using lectin histochemistry, and the mRNA of sialyltransferase was evaluated by in situ hybridization histochemistry. Sambucus nigra agglutinin (SNA), which recognizes terminal sialic acids, strongly stained the glandular mucous cells of normal subjects, but not those of patients with chronic sinusitis. In situ hybridization histochemistry showed that the expression of alpha2,6 sialyltransferase mRNA was decreased in the secretory cells of patients with chronic sinusitis. Our present results suggest that a reduction in sialyltransferase activity at the mRNA level in the nasal glands may lead to the persistence of chronic sinusitis.     

Population pharmacokinetics of vancomycin in Japanese adult patients

MICA is a new polymorphic gene in the HLA region expressed in epithelial cell lines and gastrointestinal epithelium. Little is yet known about the MICA protein, and the pattern of its expression by freshly isolated cells has not been established. In the present experiments, we used antibodies raised in rabbits against alpha1 and alpha2 domain-peptides to study the expression of MICA. By western blot and immunoprecipitation, we detected a band of 62 000 Mr in various cell lines (THP-1, U937, HeLa, A431, Raji, MOLT-4, and HUV-EC-C) and in freshly isolated keratinocytes, endothelial cells, and monocytes but not in CD4+ and CD8+ T cells, and CD19+ cells (B lymphocytes). It was not possible to up-regulate the expression of MICA in different cells by stimulation with gamma-interferon, but the expression of MICA was induced in phytohemagglutinin-stimulated T cells. We confirmed that MICA is expressed at the cell surface by flow cytometry. Results of immunoprecipitation studies of beta2-microglobulin (beta2m)- or MICA-depleted, metabolically labeled HeLa cells indicated that MICA was not associated with beta2m. Although the function of MICA is still unknown, its restricted pattern of tissue expression, the fact that it is expressed on the cell surface, and its polymorphic nature suggest that this new molecule, encoded close to HLA class I, may play a role in the interaction between epithelial cells and cells of the immune system.     

Distribution of Porphyromonas gingivalis in adult periodontitis patients

Porphyromonas gingivalis (P. gingivalis) is considered to be a pathogenic factor in adult or rapidly progressive periodontitis. The purpose of this study was to evaluate the distribution of P. gingivalis in the dentition of adult periodontitis patients using a nonradioactive DNA probe, and to compare the presence of P. gingivalis with clinical parameters. Twelve adult periodontitis patients were examined. Subgingival plaque samples were taken from 4 sites of all the remaining teeth using a paper point. At the same time, probing depth and bleeding on probing (BOP) were also recorded. Plaque samples were investigated using a whole genomic DNA probe from P. gingivalis (ATCC 33277) modified with bisulfite. The detection, percentage and amounts of P. gingivalis present were statistically compared with probing depth and BOP in each patient. P. gingivalis was detected in all patients examined. The detection percentage was 35% of all sample sites. When the probing depth was over 4 mm or BOP was positive, the detection percentage of P. gingivalis significantly increased (P < 0.01). As more P. gingivalis was identified, the percentage of sites with deep probing depth or that were BOP positive increased significantly (P < 0.01). However, P. gingivalis was also detected in clinically healthy sites, and P. gingivalis negative sites with deep probing depth or that were BOP positive existed in the same patient. These results indicate that P. gingivalis play an important role, but is not the only microorganism responsible for adult periodontitis.     

Bone marrow transplantation in adult thalassemic patients

One hundred seven adult patients with thalassemia aged from 17 through 35 years and transplanted from HLA-identical siblings between November 1988 and September 1996 were evaluated on December 31, 1997. The outcome experience of 20 consecutive patients transplanted between November 13, 1988 and January 10, 1991 and reported in September 1992 is updated after 5 additional years. The experience on 87 patients transplanted between May 1991 and September 1996 is described and evaluated as of the end of December 1997. Of 107 patients, 69 survive between 1.5 and 9 years after transplantation. Sixty-six of these patients do not have thalassemia and are identified as ex-thalassemic after bone marrow transplantation. The youngest survivor is 20 years old, 6 are older than 30 years, and the oldest is 37 years of age. Patients with chronic active hepatitis at the time of transplant were significantly more likely to die than patients without (P =.05; relative risk, 2.05). Marrow transplantation is a valid treatment option for older patients with thalassemia who have suitable donors and show deterioration with conventional therapy.     

Symptom distress in adult patients with cancer

Symptom distress in the adult population with cancer is of concern to clinicians who care for these patients. Increased research has been directed toward the development and refinement of symptom distress scales, the identification of determinants of symptom distress, the investigation of symptom distress as a predictor, and the examination of the relationship between quality of life and symptom distress. Findings from this research have increased our understanding of symptom distress in adult patients with cancer. However, a major limitation of work to date has been a lack of consensus related to the definition and measurement of the symptom distress construct. The purpose of this article is to address existing conceptual and methodological challenges inherent in the study of symptom distress, and to make recommendations for further research in this area.     

Permeability of the blood-ocular barrier in adolescent and adult diabetic patients

Transverse myelitis has been cited as a rare and unusual complication of systemic lupus erythematosus (SLE). A review of the literature reveals only 10 cases of transverse myelitis as the initial presentation of SLE, and only one with reported benefits from antimalarial therapy. The case of a 30-year-old woman is reviewed. She presented to the emergency room with complaints of hypogastric and low back pain. The ensuing course was one of frank urinary retention and rapidly progressing quadriparesis. Magnetic resonance imaging of the spine revealed marked edema of the cervical and thoracic spine. A diagnosis of SLE was based on positive antinuclear antibodies and leukopenia. The patient was treated with high dose methylprednisolone, plasmapheresis and pulse cyclophosphamide for 3 months. Subsequently, treatment was begun with hydroxychloroquine, and significant improvement in her neurologic and functional status was achieved after 1 month of therapy. Ten months after her onset of symptoms, the patient suffered an acute exacerbation of paraparesis and urinary retention. Again, she improved clinically after high dose methylprednisolone and pulse cyclophosphamide for 1 month. Hydroxychloroquine was continued throughout the duration of therapy.     

Noncancer deaths in white adult cancer patients

BACKGROUND: The cancer-specific death rate is a commonly used indicator in the assessment of progress against cancer. However, since the cause of death is often not substantiated and complete medical information is lacking, the validity of cancer-specific mortality rates is being questioned. PURPOSE: We investigated the validity of the cancer-specific death rate by examining noncancer deaths of cancer patients in a large patient population. METHODS: Data were obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program on cancer patients diagnosed between 1973 and 1987, with follow-up complete through December 1987. The SEER database consists of 1.2 million records from nine population-based registries covering nine geographic regions of the United States. Rates of noncancer deaths in the U.S. population were obtained from the National Center for Health Statistics. Cancer mortality rates were subtracted from overall mortality rates to obtain noncancer death rates by sex and the 5-year age group for each calendar year. Excluded from the study were patients of races other than White and those diagnosed at age 85 years or more due to absence of noncancer death rate comparisons. Also excluded were cancer cases discovered at autopsy and in persons less than 20 years of age. The statistical analysis employed a log-linear model. RESULTS: The ratio of patient-to-general-population noncancer death rates, as calculated by dividing the number of patient noncancer deaths per year by the number found in the matched U.S. population data and referred to as the noncancer relative hazard, is considered significant with values greater than 1 for those with all cancers combined and for the common solid tumors examined. Of the 12 leading causes of death other than cancer in the patient population, the most common causes were circulatory and respiratory failures. The noncancer relative risk of death decreased rapidly after diagnosis and also decreased with the patient's age at diagnosis. It increased slightly with the calendar year of diagnosis. CONCLUSIONS: Because more noncancer deaths occurred shortly after diagnosis, it appears that this excess was caused by treatment of the cancer. Generally, cancer-specific death rates underestimate the mortality associated with a diagnosis of cancer. Therefore, because the degree of underestimation changes with time, an examination solely of cancer-caused mortality in assessing progress against the disease is incomplete.     

Imaging of the salivary glands

The most common conditions affecting the salivary glands are calculi, inflammation and tumours. Plain radiography may be useful, especially in showing calculi. Sialography is the examination of choice for inflammatory diseases, whereas ultrasonography, computed tomography and magnetic resonance imaging are particularly useful in evaluating masses in the salivary glands. Radionuclide studies are sometimes helpful in evaluating inflammatory or tumoral diseases. Each technique has its place, and the methods are often complementary. In this review article the authors present the techniques that they use in evaluating diseases of the salivary glands.     

Changes in the adrenal glands in menigococcemia

Post-mortem morphological, histochemical, and morphometric investigations of the adrenals in 46 deceased patients who suffered from meningococcemia with and without lesions of the meninges were carried out. The control group was composed of 7 practically healthy persons who had perished suddenly as a result of craniocerebral trauma. It was shown that the adrenals might often be seriously damaged in meningococcemia without clinical and morphological signs of meningitis. Hemodynamic disorders, in particular, involvement of the vessels of the microcirculatory bed, contributed considerably to the lesions of the adrenals. However, even in meningococcemia free from signs of meningitis, in a number of cases individual areas of the cortex retained a high functional activity. In meningococcemia combined with lesions of the meninges, despite considerable damage of the cortical layer, in the majority of cases there were evidences of the tense functioning of the adrenal cells.     

Seminal vesicle cysts in the patients with adult polycystic kidney disease

Hemifacial spasm features myoclonic-like, paroxysmal, unilateral muscle twitching, attributable to vascular compression at the facial pontine root entry zone. We present the case of an 85-year-old man who presented with idiopathic hemifacial spasm with onset 23 years before. For the last 5 years, he was successfully treated with botulinum toxin injections. However, occasional nitrate intake for precordial pain promptly triggered muscle twitching. Vasodilation may exacerbate not only cases of hemifacial spasm, but even of trigeminal neuralgia, both recognized as neurovascular compressive syndromes.     

Some issues in the assessment of HIV among older adult patients.

Due to burgeoning numbers of older adults in our population and to older adults' increased participation in high-risk behaviors, clinicians can expect to see an increase in HIV infection among this age group. The assessment of HIV among older adult patients is often difficult, however, and complicated by a lack of knowledge, implicit ageist stereotypes, and negative responses in the countertransference. A review is presented of the questions for patient interviewing, neuropsychological indicators of HIV-induced dementia, typical responses in the countertransference, and techniques that promote effective patient interviewing. Methods of coping with the difficulties commonly experienced when dealing with a potential diagnosis of HIV among older adults are highlighted. Case examples that illustrate phobic countertransference in response to assessment of HIV among three elderly patients also are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Vesico-ureteric reflux in adult patients with spinal injury

OBJECTIVES: To review the incidence, aetiology, treatment and prognosis of vesico-ureteric reflux (VUR) in patients in a regional spinal injuries centre. PATIENTS AND METHODS: A retrospective review of radiological investigations revealed 34 of 447 (8%) patients with VUR on at least one study. The notes of these patients were examined to determine their management and outcome. RESULTS: Most patients developed VUR within 4 years of injury; the underlying intravesical pressure was high in half the patients studied. Patients were managed aggressively with a variety of medical and surgical techniques. The VUR of 15 patients resolved completely and in three patients there was some improvement. Renal function deteriorated in three patients as assessed by isotopic scanning. Two patients were transferred to our unit in end-stage renal failure associated with VUR and died within one year. CONCLUSIONS: VUR continues to be a problem in patients with spinal injury and remains potentially fatal through the effects of high transmitted pressure and infection. Renal failure does not always develop as a consequence of the combination of VUR and high intravesical pressure. No single aetiological factor for VUR was found. With active early treatment, the incidence of VUR can be minimized and long-term complications avoided.