Immunotherapy for non-Hodgkin''s lymphoma

The genital human papillomavirus (HPV) is directly associated with cervical cancer, the second most common form of cancer among women. The study was guided by a synergistic interaction model of HPV risk factors. The relative risk of selected risk factors and cofactors associated with genital HPV infections was identified. Women at highest risk for acquiring an HPV infection had (a) initiated sex before age 15, (b) more than four lifetime sex partners, (c) more than one "once only" sexual partner, and (d) chosen male sex partners who previously had > 16 other female sex partners. Cofactors that increased risk by possibly contributing to progression of genital HPV infection were initiating oral contraceptive use before age 15 and having acquired more than three other sexually transmitted diseases. Past and current smokers were at a slightly higher risk compared to nonsmokers. Although other studies have identified risk factors, few have identified the relative risk of these factors.     

Calcification in untreated non-Hodgkin''s mediastinal lymphoma

We report a case of calcifications in mediastinal non-Hodgkin's lymphoma. Although calcification may occur in lymphoma after chemotherapy or radiotherapy in areas of fibrous healing and scar formation, it has been reported only rarely in untreated non-Hodgkin's lymphoma.     

Therapeutic possibilities in non-Hodgkin''s lymphoma]

The -175 (T-->C) G gamma hereditary persistence of fetal haemoglobin is a very rare promoter mutation occurring in Caucasians as well as in African-Americans. Heterozygotes for this non-deletional HPFH show 20% HbF, mostly of G gamma type. We describe here a healthy Sardinian man who coinherited -175 (T-->C) G gamma HPFH with the beta-thalassaemia codon 39 nonsense mutation in trans; he showed 64% HbF, 100% of G gamma type. Although the beta-globin haplotype pattern (II/II) was indicative of the presence of the A gamma T allele on both chromosomes, the A gamma T expression was undetectable by HPLC even in red cell populations separated by age. The proband was, moreover, homozygous for the -4 bp deletion at position -225 to -222 of A gamma promoter which has recently been associated with decreased A gamma T globin expression. These findings suggest that this maximal overexpression of G gamma-globin probably reflects intensified stimulation of the mutated G gamma promoter in this hitherto undescribed genetic condition.     

Sister Joseph''s nodule in non-Hodgkin''s lymphoma

Sister Joseph's nodule is traditionally regarded as a sign of poor prognosis in untreatable malignancy. We describe a patient with a metastatic umbilical nodule in non-Hodgkin's lymphoma who had a good outcome. The possible mechanisms of tumour spread to the umbilicus and reasons for its rarity in lymphoma are discussed. The need for histological confirmation to exclude treatable disease is emphasized.     

Spontaneous regression of intermediate-grade non-Hodgkin''s lymphoma

The needles of Taxus wallichiana gave a new brevifoliol derivative whose structure was established by spectral data.     

Primary non-Hodgkin''s lymphoma of the cranial vault

In the absence of a satisfactory interpretation, sudden sensorineural hearing loss is often attributed either to infective phenomena or to organic-type circulatory defects. This latter pathogenesis inevitably comes to mind in elderly patients or in the presence of signs of circulatory dysfunction. Nevertheless, the not-infrequent observation of sudden hearing loss in young persons lacking factors predictive of short-term vascular impairment makes us suppose the existence of etiopathogenetic mechanisms of a functional nature. A survey of our cases, matched with a control group, revealed the presence of lower mean blood pressure levels in the group of young patients with 'idiopathic' sudden hearing loss. This finding supports the hypothesis that a condition of haemodynamic imbalance linked to hypotension plays a role in the genesis of cochlear damage in young subjects. Such a mechanism would bear important therapeutic implications: should it be responsible for the damage in at least some cases, vasoactive drugs with a vasodilatative action could have adverse effects on the possibility of recovery.     

Primary pancreatic non-Hodgkin''s lymphoma in a renal transplant recipient

Dormant preadipocytes isolated from adipose tissue are able to differentiate into adipocytes in vitro. A few adipogenic hormones (glucocorticoids or prostacyclin, IGF-I and insulin) are sufficient to trigger the differentiation program. In preadipose and adipose cells, glucocorticoids play a cardinal role by regulating the expression of numerous genes and by increasing the production of prostacyclin which acts as an intracrine/autocrine/paracrine effector. Fatty acids and metabolites (including prostacyclin) enhance adipocyte differentiation via the activation of nuclear peroxisome proliferator-activated receptors (PPARs). PPARs then modulate positively the expression of various lipid-related genes involved in triacylglycerol accumulation. These in vitro observations emphasize the importance of the hypothalamic-pituitary-adrenal axis and provide also a link which may take place in vivo between high-fat diets and the excess of adipose tissue development.     

Value of radiotherapy in disseminated high-grade non-Hodgkin''s lymphoma]

The usefulness of immunohistochemical demonstration with anti-bromodeoxyuridine (BrdU) monoclonal antibody for estimating proliferative activity was evaluated in experimental meningeal carcinomatosis model. The experimental model was developed by inoculation of 1 x 10(4) Walker 256 carcinosarcoma cells into the cisterna magna of female Wistar rats. Every consecutive day after tumor inoculation, the rat was perfused by saline and then sacrificed 30 min after intravenous BrdU (200 mg/Kg) injection. The brain was removed, fixed in 80% ethanol and embedded in paraffin. Coronal sections of the brain 6 mu in thickness were obtained and stained immunohistochemically using the indirect immunoperoxidase (ABC) method with anti-BrdU monoclonal antibody (Becton-Dickinson). The sections were counterstained by hematoxylin. Labeling index (LI) which represented the percentage of tumor cells in synthetic phase was obtained by counting immunoreactive cells under the microscope. LI was as low as 10.8% to 16.9% in the first 3 days after tumor inoculation. Four to 6 days after tumor inoculation when tumor cells grew several layers in the subarachnoid space, LI was 24.0% to 40.1%. LI increased to reach a plateau around 40.7% to 48.2%, 7 to 9 days after tumor inoculation. Ten days after inoculation when necrosis appeared in the tumor, BrdU-positive cells declinded and LI was between 29.1% to 35.0%. It is a useful method to estimate the proliferative activity of the experimental brain tumors, design treatment modalities and evaluate the effect of chemotherapeutic agents by using immunohistochemical demonstration with anti-BrdU monoclonal antibody. Therefore, we suggest that chemotherapy against malignant leptomeningeal tumors shall be carried out in early or intermediate stage before the proliferative activity reaches its plateau stage.     

Ultrasonographic appearance of non-Hodgkin''s lymphoma in a pregnant woman

Non-Hodgkin's lymphoma during pregnancy is rare. We report a case of non-Hodgkin's lymphoma detected in a pregnant women. She was initially diagnosed as having an ovarian tumor by ultrasonography, but definitive diagnosis was made at the time of cesarean section. After delivery she took combined chemotherapy for 7 cycles and is in complete remission over 1 year.     

Molecular pathology of acquired immunodeficiency syndrome-related non-Hodgkin''s lymphoma

The assumption that Amish cultural value of cooperation leads to greater longevity, prosperity and well-being among elders was examined using historical demographic and ethnographic analysis in a conservative Old Order Amish community. Migration, fertility, mortality and morbidity data since 1948 were used to identify population structure. The population pyramid in the Amish community (3% of the population over age 60, compared to 18% of the neighboring non-Amish rural area) is largely determined by natural fertility with low infant mortality. Household ethnography explored health beliefs, access to health care, caregiving patterns, and economic strategies. The perception that community cooperation and altruistic behavior were of benefit to Amish health is supported by mortality rates. Amish age standardized death rates were 19% below the US death rate in 1960. Migrating to form new communities and selectively utilizing acute (but not preventive or public) health care services, emerged as strong cultural patterns that facilitate reproductive success among the Amish.     

Bilateral non-Hodgkin''s lymphoma of the breast mimicking mastitis

We recently encountered a case of recurrent non-Hodgkin's lymphoma manifested after a long period of quiescence as bilateral involvement of the breasts. This 37-year-old woman had stage IVA nodular poorly differentiated lymphocytic lymphoma diagnosed 9 years previously and was followed up without treatment. She was lost to follow-up after 4 years but had been in good health until seen with malaise and fever and pain, swelling, and erythema involving both breasts. Biopsies of lymph node and bone marrow showed a high-grade non-Hodgkin's lymphoma (lymphoblastic lymphoma) of B cell origin with central nervous system involvement. Combination chemotherapy produced a dramatic remission, but the patient died of Pseudomonas septicemia.     

Radiotherapy results in early stage low grade nodal non-Hodgkin''s lymphoma

Severe lactic acidosis usually accompanies intense endurance exercise. It has been postulated that glycogen depletion working in concert with elevated muscle and plasma lactate levels lead to a concomitant reduction in pH. Their cumulative effect during prolonged physical exertion now leads to muscular fatigue and eventually limit endurance capacity. Therefore in the present study, dichloroacetate (DCA), a compound which enhances the rate of pyruvate oxidation thus reducing lactate formation, has been evaluated in a validated rat model of sub-maximal exercise performance. Male rats (350 g) were divided into two groups (control-saline, i.v. and DCA 5 mg/kg, i.v.) and were exercised to exhaustion in a chamber (26 degrees C) on a treadmill (11 m/min, 6 degrees incline). When compared to controls, the DCA-treated rats had longer run times (169 vs 101 min) and a decreased heating rate (0.020 vs 0.029 degrees C/min). In addition, DCA attenuated the increase in plasma lactate (28 vs 40 mg/dl) and significantly reduced both the rate and absolute amount of depletion of muscle glycogen stores. These results suggest that the activation of pyruvate dehydrogenase activity by DCA resulted in a reduction in the rate of glycogenolysis in addition to decreasing lactate accumulation by presumably limiting the availability of pyruvate for conversion to lactate, therefore increasing muscle carbohydrate oxidation via the TCA cycle. Thus DCA effected a significant delay in muscle fatigue.     

Primary non-Hodgkin''s lymphoma of the larynx in an AIDS patient

BACKGROUND AND OBJECTIVES: Interscalene brachial plexus block is a useful technique to provide anesthesia and analgesia for the shoulder and proximal upper extremity. The initial needle direction at the interscalene groove has been described as being "perpendicular to the skin in every plane" (1). A cross-sectional (axial) approach may offer a more easily conceptualized directed needle placement. The purpose of this study is to define the cross-sectional anatomy and idealized needle angles important to interscalene brachial plexus block. METHODS: Following IRB approval, 50 patients were studied. Cross-sectional volume coil T1-weighted magnetic resonance images (MRI) were obtained from 50 patients undergoing cervical region imaging for other reasons. At the interscalene groove, a simulated needle path to contact the ventral rami or trunks of the brachial plexus was approximated at the level of C6 or C6-C7 interspace. The angle of this needle path intersecting the sagittal plane was recorded for each patient. RESULTS: The mean angle of the simulated needle path relative to sagittal plane was determined to be 61.1 +/- 6.1 degrees (range, 50-78 degrees). In 13 of 50 (26%) MRI scans, the cervical nerve roots were not visualized at the level of C6 and were measured at the C6-C7 level. CONCLUSIONS: These findings suggest initial needle placement at the interscalene groove should be angled less perpendicularly relative to the sagittal plane than is often observed. A cross-sectional approach enables more practical visualization of initial needle placement. A more accurate initial needle placement may minimize the number of needle passes necessary to contact the nerve roots, thereby more efficiently obtaining a successful block.     

Intraoral non-Hodgkin''s lymphoma in seven patients with acquired immunodeficiency syndrome

Transcranial Doppler sonography (TCD) of the middle, anterior and posterior cerebral arteries and of the basilar artery was used to evaluate the mean blood velocity (V mean) and the pulsatility index [PI = (V systolic-V diastolic)/V mean] as a vascular resistance index in 63 patients (male 40, female 23, mean age 43 +/- 19 y) with bacterial meningitis (n = 33, including 2 patients with fungal meningitis) and viral meningitis (n = 30) within 12 h after admission of the patients. The findings were similar for all intracranial arteries. Compared with reference values of 69 healthy volunteers [V mean of middle cerebral artery [MCA] 57 +/- 13 cm/s, MCA-PI 0.83 +/- 0.15], MCA-V mean was increased in patients with Glasgow coma scale (GCS) scores of 14 and 15 (71 +/- 18 cm/s; t-test: p < 0.001), not significantly different in the patients with GCS scores of 10-13 (55 +/- 21 cm/s) and decreased in those with GCS scores of 3-9 (42 +/- 21 cm/s, p < 0.01). The MCA-PI increased from 0.93 +/- 0.22 in the patients with GCS scores of 14-15 to 2.81 +/- 2.06 in those with GCS scores of 3-9 (p < 0.001 vs. controls). By regression analysis, MCA-V mean decreased and MCA-PI increased with decreasing GCS scores (p < 0.001). Only in patients with bacterial meningitis was the Glasgow outcome scale (GOS) score lower the more the MCA-PI was increased (regression analysis p < 0.001). We conclude that in patients with bacterial and viral meningitis, and in a good clinical state, the cerebral blood flow seems increased by hyperemia; with clinical deterioration the cerebral haemodynamics worsen. However, the early assessment of the cerebral blood flow by TCD seems useful for predicting outcome in bacterial meningitis only.     

Investigation of the molecular changes during chemotherapy in non-Hodgkin''s lymphoma

In addition to the circulating renin-angiotensin system (RAS), a local system has been postulated in the anterior pituitary because immunodetection of its components in various mammalian species. However, different cell types appear to be involved in different species, and there is no general consensus on the subcellular localization of prorenin, renin and angiotensinogen. In this ultrastructural study, we investigated and quantified the presence of these components using double or triple immunogold labeling methods, in all the immunologically identified glandular cell types of the rat anterior pituitary. In contrast to previous reports, all these components were identified not only in lactotropes and gonadotropes but also in somatotropes, corticotropes, and thyrotropes. The highest levels were detected in lactotropes and gonadotropes, and renin gave the greatest signal. Angiotensinogen, prorenin, and renin were co-localized in the secretory granules of all rat pituitary glandular cell types. The simultaneous detection of the substrate (angiotensinogen) and both its specific cleavage enzyme and its proenzyme within the same granule suggests intragranular processing of this component. Moreover, the localization of these three constituents in the secretory granules also suggests that, in the rat anterior pituitary, they follow the regulated secretory pathway.     

Pregnancy and risk of non-Hodgkin''s lymphoma: a prospective study

Glucose 6 phosphate dehydrogenase (G6PD) was estimated in the leucocytes of 35 patients with acute non-lymphocytic leukemia (ANLL) and 10 patients with chronic myeloid leukemia (CML). G6PD levels were found to be significantly decreased in majority of the patients with ANLL while it was increased in all CML patients. Variation in G6PD was found to be dependent on the percentage of myelocytes inANLL. Cytogenetic analysis was also carried out in these patients. Correlation analysis of leucocyte G6PD activity and karyotype with prognostic assessment clearly indicated the association of (s) high percentage of chromosomal abnormalities especially translocations, (b) low survival and remission rates, with patients having decreased G6PD activity when compared to patients with normal activity in ANLL. The studies indicate that leucocyte G6PD may be useful as a diagnostic and prognostic tool.     

Rituximab: a new therapeutic monoclonal antibody for non-Hodgkin''s lymphoma

Little is known about the psychiatric diagnosis and treatment of adolescents who sexually offend. We therefore describe an adolescent sex offender who met DSM-IV criteria for multiple paraphilias (except for the age criterion), bipolar type II disorder, and OCD, whose paraphilic urges and behaviors, depression, and violent obsessions responded to open label fluoxetine after failing to respond to long-term residential treatment. Although only a single and uncontrolled observation, this case suggests that some adolescent sex offenders may in fact have paraphilias, and that paraphilias in adolescents, like those in adults, may respond to serotonin reuptake inhibitors.     

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.